AIO Membership Application Form Please enable JavaScript in your browser to complete this form.Name *FirstLastPractice Name *Practice Address *Practice Address (copy)Practice Address (copy) *Practice Address (copy) (copy) *Email *Email (copy)The Association produces two membership listsPlease tick box A or B: *A) I give permission for my Practice details to be circulated on the AIO Public ListB) I do not want my name on the Public List. (copy)Categorys Full Member £100 per yearAssociate Member £100 pre yearAffiliate Member £100 per yearNewly Qualified Member £50 for year 1 plus £10 per year thereafterStudent Member £10 per yearRetired Member £50 per yearSocial Member £50 per yearPractice Membership If one qualified Optom or DO £100If two qualified practitioners £200If three qualified practitioners £250 If four or more qualified practitioners £300Practice MembershipPlease Indicate BelowI wish to pay monthly (Full and Associate membership can also be paid on a monthly basis @ £10 per month).I wish to pay annuallyI have made a BACs payment Bank details: Account number: 31481968 Sort code: 30–99–20I have enclosed a chequeParagraph TextSingle Line Text (copy) (copy) *Guidance NotesSingle Line Text (copy) (copy) (copy) (copy)Regarding membership categories (copy) (copy) (copy)Single Line Text (copy) (copy) (copy) (copy) (copy) (copy)Regarding membership categoriesRegarding membership categories (copy) (copy) (copy)Regarding membership categories (copy)Regarding membership categories (copy) (copy)For more information PhoneSubmit Share this:TwitterFacebook
