Membership Registration Form

You are about to register for membership of the Patient Information Forum. Unless otherwise agreed a fee is payable for this membership.

Required fields are marked: *

* I wish to join the Patient Information Forum as:

Main Organisation, Supporter or Partner membership name:

Personal details

Title (eg Mrs, Dr):
* First name:
* Surname:
* Job title:
Department:
* Organisation name:
Organisation website:
* Address line 1:
Address line 2:
Address line 3:
* Town:
* County:
* Country:
* Postcode:
Tel (landline):
Tel (mobile):
* eMail:

* Which Sector does your organisation belong to?

How did you find out about PiF?


If other, please specify:

Confirmation of membership

  • When you submit this form you will receive a confirmation email.
    It is important you click on the link in this email within 7 days to initiate the membership process.
  • You will receive a further email stating that your registration for membership is complete and the process for you to become a member of PiF has commenced.
  • You will then receive a final email containing formal confirmation of your membership, followed by an email providing an invoice if appropriate.

Payment

After you submit this form an invoice will be sent to you by email if there is a membership fee to pay. Please pay this promptly within 30 days of the date on the invoice.

Invoice details

If you wish the invoice to be sent to your Finance Department, please provide the following information in the box below:

  • Purchase order number (if this is required, please ensure that you provide us with this number as soon as possible)
  • Finance contact name
  • Finance postal address
  • Finance telephone number
  • Finance email address
  • Any additional special instructions

Please provide additional details as above if necessary:

How to pay

Credit card

Please click on the PayPal link on the next page.

BACS

Pay by BACS payment directly into the PiF bank account. Details of how to pay by BACS can be found at the bottom of the invoice which will be sent to you.

Cheque

You can post a cheque made payable to 'Patient Information Forum Limited' to:

c/o Sarah Smith, Operations Director
Patient Information Forum (PiF)
500 Chiswick High Road
London W4 5RG

Notes

Whichever payment method you use please ensure you include the invoice number, your name and organisation as the reference (including on the back of the cheque) to ensure we can match your payment with your invoice.

Invoices are sent by email only. If you require a hard copy to be sent by post please let us know.

If you have any queries regarding this membership application please contact admin@pifonline.org.uk