Name:

Title:

Organisation:

Work Title:

Address:

Postcode:

Tel:

Fax:

Mobile:

Email:

My particular areas of interest are:

We prefer payment by standing order and offer discounts on your annual membership fee if you set one up
Please tick the appropriate box and then contact your bank or building society to set up your standing order
Lapidus account details are: NatWest, Sort code: 60-21-37. Account No: 56553730
Please add the reference 'Lapidus Membership' when setting up your standing order (and if your account name is different from the name on this form, please specify)

£27 (individual)
£17 (unwaged/student)
£57 (professional membership*)
£72 (organisations)

OR

I am sending a cheque made payable to LAPIDUS
with a print-out of this form to
BM Lapidus
London
WC1N 3XX

£30 (individual)
£20 (unwaged/student)
£60 (professional membership*)
£75 (organisations)

* Professional Membership applications - please see Membership page for required documentation and send to the above address with your form; please await confirmation email before paying your fee

I am / am not happy for my contact details to be circulated to other Lapidus members

Details not to be circulated: