British Sleep Society Application Form

Joining or Renewing your Membership

BSS Membership Application / Renewal

New Application Renewal of Application

Title	Other title:
First Name(s)
Surname

Address
No, Street
Town, City
Postcode

Tel
Fax
Email

Research / Clinical Interests (give up to 5 words / phrases)

1.
2.
3.
4.
5.

Additional Information for the BSS Membership Database
(No information will be passed onto a third party without prior permission)

Department Name:

Post Held:

other:

Facility Type:

other:

Please choose one or more boxes which best describes your facility:
Clinical	Clinical Research
Research	Education

Areas of Special Interest
(brief outline)

Note: For purposes of printing please only write in the viewable area of the above box. (The viewable area of box will expand further allowing more content, as you type, if you are using a newer browser e.g. IE 6+, Opera 6+ etc.)

We are occasionally approached for information by GPs, media etc. We would therefore like to produce e-mail groups covering particular areas of specialty. If you can help with this please select one or more of the areas given below. Thank you for your assistance. More details about e-mail groups.

E-mail Groups

All Information	Insomnia	OSA / RLS
Media	Education	Paediatrics

Please note: your e-mail will not be given out to anyone without asking your permission first.

I have:
	enclosed a cheque for £10 made payable to the "British Sleep Society"
	arranged with my bank for a standing order to be paid to: British Sleep Society, Barclays Bank, Wantage. Account No. BSS 80330035 Sort Code: 20-90-91

Signature ........................................... Date ......................

Please print up this form, then sign and date it, and return it by post with your payment to: Membership Services, British Sleep Society, PO Box 247, Colne, Huntingdon, PE28 3UZ. The British Sleep Society is a Registered Charity in England and Wales (No: 1009880).

Alternately download and hand fill the PDF version of the application form.

The British Sleep Society Website, sleeping.org.uk, website content copyright © British Sleep Society, 2003. To comment on the contents of this website please email: editorial@sleeping.org.uk. The British Sleep Society is a registerd charity in England and Wales (Reg. No. 1009880).