Name

Prof/Dr/Mr/Miss/Ms

Job Title

Dental School

Telephone Number

Email Address

Address

Town/City

Postcode

Is this your work or home address? Is this your work or home address?HomeWorkOther

Declaration Declaration To, The Directors, The Association of British Academic Oral and Maxillofacial Surgeons The Royal College of Surgeons, Nicolson Street, Edinburgh,EH8 9DW. I, hereby consent to become a member of The Association of British Academic Oral and Maxillofacial Surgeons (Company number SC312148) (the "Company") subject to the memorandum and articles of association of the Company, and authorise you to enter my name in the Company’s register of members as a member of the Company. I agree that if the Company is wound up while I am a member of the Company or within one year after I cease to be a member of the Company, I will contribute such amount as may be required, not exceeding £1, in terms of clause VI of the Company's memorandum of association. Please complete the following declaration. By checking the Declaration you agree to the following statement: To, The Directors, The Association of British Academic Oral and Maxillofacial Surgeons The Royal College of Surgeons, Nicolson Street, Edinburgh,EH8 9DW. I, hereby consent to become a member of The Association of British Academic Oral and Maxillofacial Surgeons (Company number SC312148) (the "Company") subject to the memorandum and articles of association of the Company, and authorise you to enter my name in the Company’s register of members as a member of the Company. I agree that if the Company is wound up while I am a member of the Company or within one year after I cease to be a member of the Company, I will contribute such amount as may be required, not exceeding £1, in terms of clause VI of the Company's memorandum of association.

Digital Signature Digital Signature By checking the Digital Signature Box here indicates that you have read and agree to the terms of ABAOMS. Before signing and submitting this document, please verify that the content and information provided is correct.