NetIKX: Network for Information and Knowledge Exchange

Below is the application form for NetIKX membership. Please complete and submit. * indicates a required field

Personal Details:
Title:*
First Name:*
Last Name:*
Position or Job Title:
Organisation Name*: (or your own name if not applicable)
Address:*
City:*
Postcode:*
Country:
Telephone Number:*
Additional Tel. Number:
E-mail Address:*
Confirm e-mail Address:*
Password:* (From 5 to 15 alphanumeric characters)
Confirm Password:*
Password reminder clue:*
Membership Details:
Membership Class:*	About Membership
Please note that no VAT is due.
Payment Details:
Purchase order number:
	I will pay by cheque & require an invoice/receipt *
	I will pay by bacs & require an invoice.*
	Please check the box to the left to confirm that you agree to NetIKX storing the information on this Form and using it for the sole purpose of contacting you regarding NetIKX.*

Once you have submitted the form please send cheques payable to NetIKX (if appropriate) to: The Treasurer, PO Box 54831, London, SW1V 2YF Please print the form for your records before clicking the submit button.