BMLA Membership Form

Title (eg Mr, Mrs, Ms, Miss, Dr, Prof) *

First Name: *

Last Name: *

Telephone: *

Fax:

Email: *

Confirm Email: *

Company or Organisation: *

Contact address or Mailing List:
It is advisable to be very specific and to choose personal address if possible, to ensure that the journal copies do not get 'lost' in the internal institutional mail system. Please note that your mailing address will be passed on to the publishers of the journal. *

Class of Membership:
Please enter Full Membership (£65) or Basic Membership (£25). Full Membership confers full voting rights and all benefits of BMLA and ELA, annual subscription for the official BMLA journal, Lasers in Medical Science published by Springer. The annual fee is less than the cost of the journal alone! Basic Membership confers full voting rights to the BMLA, not ELA Membership and not the journal at a discounted rate. *

University Degree(s):
Please state Degree Subject and date of award. *

Diplomas, Certificates:
Please state date of award.

Memebership of Professional Bodies:

Present Appointment:
Please state Post Held, Name, address and telephone if different from above. *

Laser/IPL Interests and Speciality: *

Type of Laser Employed:
Please give full details *

Training Undertaken:

Number of Years Laser Usage: *

Supportive Staff
Technical, medical, physics, research staff etc

Other Relevant Details:

Nominated by:
Applicant should be nominated by an existing member of BMLA. If you are unable to identify a BMLA member who will nominate you, please provide a brief CV along with your application form.

Method of Payment
This only applies once your membership is accepted and confirmed

Click for Cheque Click For Standing Order

Name of the account:
We regret we do not accept payments by credit or debit card. *

Additional Information For further information on payments, standing orders etc please visit the payments page on the left navigation.

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