British Division of the International Academy of Pathology

Change of Membership Details

If our record is incorrect, or there is any change in the coming year, please print out and complete this form and return it to the Administrative Secretary.

Please use block capitals

(Alternatively, Email the necessary information to: bdiap@blueyonder.co.uk)

SURNAME ........................................................

FORENAMES ......................................................................

TITLE (Dr/Prof etc) ............................................

STATUS (Ordinary/Honorary/Senior) ............................................

NEW ADDRESS ........................................................................

.............................................................................

.........................................................................................

................................POSTCODE .....................

COUNTRY ........................................................

TELEPHONE ......................................................

(including STD and Extension)

FACSIMILE ......................................................

Email ......................................................

OLD ADDRESS ........................................................................

......................................................................................................

............................... POSTCODE .....................

SIGNED .........................................................

DATE ...........................................................

Please return to:

Mrs C Harris
Administrative Secretary, BDIAP
PO Box 73
Westbury-on Trym
BRISTOL BS9 1RY
U.K.