Membership Application

Organisation Name:
Title:
Firstname:
Surname:
Address:
City:
Postcode:
Telephone:
Fax:
Email Address:

The email address must be that of a named person ie not "enquiries" or "info" nor similar
Please select the option that most accurately describes your organisation's activities:  Claims Management Company
 Law firm (solicitor or chambers)
 Claims handler/manager (non legal)
 Medico-legal agency
 Rehabilitation/treatment provider
 Insurer
 Endowment/Financial Services
 Other
Membership Type  firms with ten employees or more - £960 plus VAT per annum
 firms with fewer than ten employees - £480 plus VAT per annum
Please state which regulatory body you are registered with:
If you are Ministry of Justice registered, please give your registration number:
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