Application form

I hereby apply to be come a member of The Royal London Hospital League of Nurses. I enclose the completed bankers standing order for the annual subscription or a cheque for £10 for my first year's subscription.

Surname: Mr, Mrs, Miss, Ms, other title

Forenames (in full)

Maiden name (if applicable)

Permanent address:

Training School/College

Date Training Commenced:

Date Training completed:

UKCC PIN number:

Date of registration of initial nursing qualification

Present position

Work address

The League publishes a membership list, which is circulated to members both in and outside the EEC. Please tick the box if you do NOT wish your details to be included in membership lists. 

Signature:                                        Date:

Standing Order Mandate

To The Manager

Name of your bank

Postal address

Postcode

Name(s) of account holder(s)

Account number:

Please pay Coutts & Co, St Martin's Branch. 

Sorting Code No. 18-00-02

For the credit of: The Royal London Hospital League of Nurses General Fund Account, Number 35582230

The sum of  £.........................(write amount in figures)

...................................................(write amount in words)

Commencing on....................................(write date of first payment) and thereafter every year.

Signature

Date