Link to Annual Scientific Review 2010

Standing Order Form*

Name and Branch Address of Bank

Please pay to Barclays Bank, 38 Hagley Road, Edgbaston, Birmingham, B16 8NY (Sort Code: 20-07-82) for the credit of the account INTERNATIONAL LEAGUE AGAINST EPILEPSY (Account Number 80485055) the sum of £25 (twenty-five) on 1st next month and then annually on 1st January until further notice.
Please include my first name and surname with reference.

Please cancel any existing Standing Order to the ILAE.
Name
Address
Account Number
Sort Code
Signature
Date

Click here for the Standing Order form in word or pdf format. Please print, complete & sign this form and return it to: Eleanor Harris, ILAE UK Chapter c/o Institute of Neurology, Room 611, Queen Square House, Queen Square, London WC1N 3BG

Alternatively, once completed please scan the document into your PC and email it to members@ilae-uk.org.uk

*A completed Standing Order form is required to be sent at the same time as the Membership Application Form