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Please print this page using the print button on your browser, complete in block letters and post with your subscription payment to:

Rachel Everard (SIG Treasurer)
Speech Therapy
City Lit
Keeley Street
London
WC2B 4BA

Please make cheques payable to: SIG in Disorders of Fluency

I wish to become a member of the SIG Disorders of Fluency and enclose £20 (standard membership) / £10 (student/retired) for the year October 2007 to September 2008.

Name:                    ____________________________________________________

Address (work/home):    _______________________________________________
                             _____________________________________________________________________
                             _____________________________________________________________________
                             _____________________________________________________________________

Postcode:                              ___________________________________________ 

Telephone No (work/home):  ___________________________________________

Email:                            _______________________________________________

RCSLT Membership No:    ____________________
or, for students
Training Establishment:  _______________________________________

Special Areas of Interest: _____________________________________________

Inclusion in the SIG membership directory is optional. The membership list is confidential however the directory may be made available to SLTS, researchers, students and other interested relevant organisations at the committee's discretion. If you would like to receive a directory please include a large SAE with your membership.

I would /would not like to be included in the membership directory (please delete)