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EUROPEAN HAIR RESEARCH SOCIETY (EHRS)
ANNUAL MEMBERSHIP DUES PAYMENT
FORM
Click
here for a Microsoft Word format annual membership dues
payment form
Send the completed form along to:
Desmond Tobin (Treasurer EHRS)
Division of Biomedical Sciences
University of Bradford
Bradford
West Yorkshire
BD7 1DP
Great Britain
Or fax to : +44 (0)1274 309742
Surname: ................................................................................................
First name: .............................................................................................
Department:
............................................................................................
Company/institution:
...............................................................................
Street, no.: ..............................................................................................
Town/city: ................................................................................................
Post code: ...............................................................................................
Country: ...................................................................................................
Title (Prof.,
Dr.,
Mr., Miss., Mrs.) ...............................................................
EHRS Annual Subscription - 50 Euro (£35)
Please note the preferred payment method is by Credit Card
(Check one)
Visa:
..................................
Mastercard:
..............................
American Express:
.........................
Card number:
.........................................................................................
Card expiry date :
_____ / ______
Card holder name:
..................................................................................
Signature for card (obligatory): .............................................................
Date: .......................................................................................................
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