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Please
fill in your details and return this form to:
Lucy Davenport-Jones, Hon.Sec. COSG, Croydon University Hospital, Croydon, Surrey, CR7
7YE
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 2011/2012 is £27.50 (TGG rate £12).
Please help us reduce costs
and save trees by giving an email contact where possible.
I enclose my 2011/2012 membership subscription
@ £27.50 (£12.00 TGG)………………………………………………….…
Please
circle as appropriate
I wish to be notified of meetings by …email …post
PLEASE SEND CHEQUE (PAYABLE TO COSG)
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