1 Membership Application Form for BANSV The British Association of No Scalpel Vasectomists I (full name) ............... am a Doctor providing a No Scalpel Vasectomy service and I wish to join the BANSV. My GMC registration number is .......... Expiry date............. I understand that participation in the Association's Annual Audit and in peer review are absolute conditions of membership. I enclose a cheque for £40.00 made out to BANSV to cover annual membership from 1st April to 31st March in any year. I understand membership brings the following advantages: . Peer group support . Peer review . Annual audit tool . Annual conference . Representation to professional bodies . Discount on equipment purchased from Schuko International . Use of initials MBANSV on professional stationery . Inclusion in BANSV website directory. Send this completed form to: BANSV Registrations, Dr Tony Feltbower, 41 Westminster Road, Coventry, CV13 3GB With a cheque for £40.00 made out to BANSV If you require a receipt of payment please tick box I WISH MY DIRECTORY ENTRY to be as follows: Doctors name ............................. Clinic name and address .................................. .................................. County............ Contact details, E mail FOR PATIENTS TO USE .......... Email for professional contacts............ Phone (patients) .................. Phone (professional contacts)............ Fax ...................... Website ..................... Vasectomies performed for NHS yes no (delete which is not applicable) Vasectomies performed in the Private Sector yes no Any other comments - we will include if we can eg cost, waiting time etc .................................. ................................... Signature .......... Date ..... Once you have completed the above, please send it to: BANSV Registrations, Dr Tony Feltbower, 41 Westminster Road, Coventry, CV13 3GB