Society Membership
* = mandatory fields
*E-Mail Address:
*Password:
*Password (Again):
Title:
*Surname:
*Name:
*Member Type:
Gender: Male Female
*Birthdate:
*Institution:
*Telephone:
*Mobile:
*Fax:
*Address Street:
*Address Number:
*Zipcode:
*City:
*Country:
*References:

*Do you have a personal Subscription (not Membership) to O&N? No Yes
*Do you receive IAO etc (Members ask about subscription)? No Yes
Address for O&N/IAO (if different from above)
Address Street for O&N/IAO:
Address Number for O&N/IAO:
Zipcode for O&N/IAO:
City for O&N/IAO:
Country for O&N/IAO:
I confirm that I am over 65 and not in full time practice
 Photo: (must be JPG)
 CV: (must be PDF)
 Do you want to have a forum membership? : Yes No
Do you want to recieve forum notifications to your e-mail? : Yes No
*Security Code:
Enter security code
Refund Policy
If you change your mind about membership, you can request a refund within 30 days of the date on which you made the payment. To request a refund, you can either, write to The Politzer Society, c/o Mr N Donnelly, Box 48, Cambridge University Hospitals, Cambridge CB2 0QQ, United Kingdom, or e-mail treasurer.politzer@gmail.com and please provide your name, address, phone and email. We will contact you with details on how we can best resolve your issue.