ࡱ> 463M  bjbj== WWljjjjjjj $fhhhhhh$ jjj"jjff*jj* db .**<0*_8L_*~jjjj MEDICAL COUNCIL ON ALCOHOL 5 St Andrews Place London NW1 4LB Telephone: 020 7487 4445 FAX: 020 7935 4479 e-mail: mca@medicouncilalcol.demon.co.uk Website: www.medicouncilalcol.demon.co.ukApplication for FULL Membership to December 2006 (Medical Practitioners) ________________________________________________________________________ To: The Medical Council on Alcohol 5 St Andrew's Place, London NW1 4LB ________________________________________________________________________ Full Name: ________________________________________________________________________ Preceding Title, Postnominal Awards and Qualifications: ________________________________________________________________________ Institute or Organisation: ________________________________________________________________________ Address including postcode: work/home ________________________________________________________________________ Telephone: ________________________________________________________________________ Fax No.: ________________________________________________________________________ Email address: ________________________________________________________________________ BOTH FULL MEMBERSHIP AND JOURNAL QUALIFY FOR TAX RELIEF AT YOUR HIGHEST RATE. Donations to MCA work are welcome at any time Please sign here if you wish any donation now and in the future to be under Gift Aid programme whereby MCA can reclaim tax. Donation enclosed now ___________________________ FULL MEMBER (medical practitioner) 50.00 For membership now to December 2006 Membership includes a copy of Alcohol &Health Handbook and the leaflet You Your Patients and Alcohol. 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