Doctors and Lawyers for Responsible Medicine
 

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Membership Form

Your details:

Title _______
Forename ___________________
Surname ___________________
Address

___________________

  ___________________
  ___________________
Postcode ___________________
Country ___________________
Telephone ___________________
Email ___________________
Professional qualifications
___________________
(where appropriate) ___________________
  ___________________

Type of membership:

Full membership
Open to doctors and scientists in medical fields, dental surgeons, pharmacists, veterinarians and lawyers.

UK & EC 35
Concessionary (retired, etc) 20
Overseas (rest of world) 42
Overseas concessionary 24

Friends of DLRM (see special offer)
Open to all other medical and legal categories and the general public.

UK & EC 20
Concessionary (retired, etc) 10
Overseas (rest of world) 24
Overseas concessionary 15

Agreement:

I wish to subscribe to DLRM and confirm that I support its objective for immediate and unconditional abolition of all animal experiments, on medical and scientific grounds.

Payment:

Please print and return to DLRM, P.O. Box 302, London N8 9HD, with a cheque (made payable to DLRM) or standing order form.

Thank you for your support.

 

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