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Please
fill in your details and return this form to:Alison Newlyn, Hon.Sec. COSG, Oral & Facial Unit, East Surrey Hospital, Redhill RH1 5RH NAME
(Dr/Mr/Mrs/Ms)……………………………………………………........................
ADDRESS……………………………......................................
.......................................................................................
PHONE NO(S)............................……………………………….
EMAIL………………....................…………….......................
CURRENT OCCUPATION (eg GDP, Spec Prac, etc)………………….MEMBER
OF BOS? COG OSG
CG
PG
TGG
UTG
COSG membership
for 2009/2010 is £27.50 (TGG rate £12).Please help us reduce costs and save trees by giving an email
contact where possible. Please
check box as appropriateI
enclose my 2009/2010 membership subscription @ £27.50 (£12.00 TGG)………………………………………………….…
I wish to be notified
of meetings by …………………email post
PLEASE
SEND CHEQUE (PAYABLE TO COSG)
Membership
cheque enclosed?
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