MEMBERSHIP FORM

THE ROBERT JONES AND AGNES HUNT ORTHOPAEDIC HOSPITAL NHS FOUNDATION TRUST

OLD OSWESTRIANS' CLUB

I wish to become a member of the Old Oswestrians' Club and for information to be sent to me each year about Club meetings.

Name ........................................................................................................

Permanent Address .....................................................................................

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Present Address ........................................................................................

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Post Held ...................................................................................................

Duration of employment at RJAH Orthopaedic Hospital, Oswestry  

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email address: ……………………………………………………

Subscription:          LIFE MEMBERSHIP            £25.00

Cheques to be made payable to “The Old Oswestrians’ Club”

I enclose a cheque to the value of £25.00 British Sterling.

SIGNED ...........................................................

DATE ...............................................................

Return to:

Mrs S Cank

Postgraduate Office

Institute of Orthopaedics

Robert Jones & Agnes Hunt Orthopaedic & District Hospital NHS Trust     

Oswestry

Shropshire

SY10 7AG