MEMBERSHIP APPLICATION FORM

Please print out and send completed form to :
Louise Harrington
Harrington Lodge
Veterinary Centre
64 Coleshill Rd
Hodge Hill
Birmingham
B36 8AB

TITLE .........SURNAME ................................................................

FIRST NAME/INITIAL ...................................................................

ADDRESS

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

PLEASE TICK THE RELEVANT CATEGORY BELOW:
Please support your application with a letter detailing any appropriate formal qualifications you hold and the number of years' experience you have in dealing with behavioural problems of companion animals.

VETERINARY SURGEON ....
VETERINARY STUDENT ....
VETERINARY NURSE ....
STUDENT VETERINARY NURSE ....
MEMBER OF APBC ....
NONE OF THE ABOVE ....

MEMBERSHIP OF RELEVANT BODIES

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MAIN AREAS OF INTEREST

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I consent to the publication of the above details in the study group's newsletter and/or their release to any third party whom the committee believes may be providing a service or information of relevant interest. You may delete this section without prejudice to your application.

SIGNATURE ............................................ DATE ............................

I enclose a cheque for £15 (£7.50 for students) made payable to CABTSG (subscription runs from April each year)