YEARLY PAID MEMBERSHIP FORM - £20 PER ANNUM
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Please Pay To: HSBC Bank The Bridge Walsall West Midlands WS1 1LN
For the account of: BIHAR JHARKHAND MEDICAL ASSOCIATION (UK.) Account No __________________ £20.00 on the day you received this order and thereafter on the same day each year until countermanded by me. Signature _________________________ Date_________________
Completed Application form with cheque should be sent to: Mr Rajesh Choudhary 8 Wesetfield Road BISHOP AUCKLAND Durham DL14 6AE Tel 01388 455906