Order Form

Membership type

Corporate (£35)

Individual (£35)

Unemployed (free)

Fully retired (free)

Company Name

Company activity

Address

City

County

Postcode

Tel

Fax

E-mail

Name (for correspondence)

Professional Qualifications

Health and Safety Interests

Purchase Order No.

Name for invoices

Receipt Method

Fax

E-mail

Post

Do you object to the group holding your membership record on computer?
This information is usually used to prepare a list of group members, mail minutes of meetings and request subscriptions.
Disclosure, although unlikely, may be made to affiliated clubs and societies only if deemed relevant by the Committee.

Data Storage

Yes

No

Do you object to the above details being circulated to group members in the annual member's directory?

Data circulation

Yes

No

Payment can be made via several methods:

Cheques made payable to MOHSG can be sent to:
Mr M Nixon, Group Treasurer
MOHSG
62 Willow Avenue
Cheadle Hulme
Cheadle, Cheshire
SK8 6AX

An invoice can be raised on receipt of a Purchase Order No.

BACS payments may also be made
Branch: Barclays, 1 Bridge Street, Stockport, SK1 1XU
Sort code: 20-82-14
Account no: 60832251

Or Paypal payment (no account required) using a variety of credit and debit cards will be accepted with an additional charge of £3. Please go to Membership Payment to complete your transaction after completing the form.