Membership
Renewal
Form
2016/2017
(for The
returning
Membershipmembers)
year runs from 1st October 2016– 30th September 2017
Please write in Capital Letters throughout this form
Your Contact Details:
Title
First name
Surname
Membership
number if known:
BAOT No:
Email:
(Please print
clearly)
Place of work:
(Please note all
correspondence is
sent via e mail)
Any changes Yes (please detail below) 
from last year?
No (please sign end of form and complete payment details) 
New contact no:
New email:
Please ensure the email address is completed correctly to facilitate future contact
Change in grade
or post:
Data Protection Statement:
By providing any of the contact details above, you are authorising the COTSS Trauma & Orthopaedics
National Executive committee members and their authorised agents, to contact you with details relevant
to your COTSS Trauma & Orthopaedics and for those details to be networked to other COTSS Trauma
& Orthopaedics members. COTSS Trauma & Orthopaedics will not disclose your personal details to any
outside person or body without your permission.
If you do not wish to be contacted by COTSS Trauma & Orthopaedics by post, email or otherwise with
items that are not directly COTSS Trauma & Orthopaedics related, please tick this box.
PLEASE SEE FOLLOWING PAGE FOR PAYMENT DETAILS
Registered Office: 106-114 Borough High Street,
Southwark, London
SE1 1LB Telephone: 020 7357
6480 Fax: 020 7450 2299 www.cot.org.uk
College of Occupational Therapists Ltd. Reg. in England No. 1347374 Reg. Charity No. 275119 VAT Reg. No. 242 7829 47
Professional Member
£30.
Rotational Post (less than
12 months in setting valid
until June 2017 only)
£20.
Student/ Associate BAOT
Member
(assistant/technician)
£10.
Bank Transfers:
HSBC account: 31202928
Sort code: 40-05-19
BANK PAYMENTS MUST INCLUDE THE REFERENCE
SSTO
Date bank transfer made………………………………………
Please make cheques payable to COT
Signed …………………………………… Date ……………………………….
Please Send Completed Form and payment to:
Paul Marshall-Taylor
5th Floor Therapy Gym
Trauma and Orthopaedics
St James Wing
St Georges Hospital
Blackshaw Road
Tooting
London SW17 0QT
Tel: 020 8725 0985
E mail: [email protected]
Registered Office: 106-114 Borough High Street,
Southwark, London
SE1 1LB Telephone: 020 7357
6480 Fax: 020 7450 2299 www.cot.org.uk
College of Occupational Therapists Ltd. Reg. in England No. 1347374 Reg. Charity No. 275119 VAT Reg. No. 242 7829 47