Membership Form

Your details:

Title	_______
Forename	___________________
Surname	___________________
Address	___________________
	___________________
	___________________
Postcode	___________________
Country	___________________
Telephone	___________________
Email	___________________
Professional qualifications	___________________
(where appropriate)	___________________
	___________________

Type of membership:

Full membership
Open to doctors and scientists in medical fields, dental surgeons, pharmacists, veterinarians and lawyers.

	UK & EC £35
	Concessionary (retired, etc) £20
	Overseas (rest of world) £42
	Overseas concessionary £24

Friends of DLRM (see special offer)
Open to all other medical and legal categories and the general public.

	UK & EC £20
	Concessionary (retired, etc) £10
	Overseas (rest of world) £24
	Overseas concessionary £15

Agreement:

I wish to subscribe to DLRM and confirm that I support its objective for immediate and unconditional abolition of all animal experiments, on medical and scientific grounds.

Payment:

Please print and return to DLRM, P.O. Box 302, London N8 9HD, with a cheque (made payable to DLRM) or standing order form.

Thank you for your support.