Those Who Are Already Fellows of the Society

Form Ex40

Those who are already Fellows of the Society

should not use this form - please use Form Ex41 instead

APPLICATION TO REGISTER FOR EXAMINATIONS IN 2017

AND TO ENROL AS AN EXAMINATION ASSOCIATE

Please use BLOCK CAPITALS

I have read and I understand the information in the general Guide to Examinations (Ex1).

I apply to register for the following examinations to be held in 2017 (please tick appropriate box(es))

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I also apply to be enrolled as an Examination Associate of the Society for the period until 31July 2017. I agree to abide by the rules of the Society and to uphold its good name.

Signed ……………………………………. Date ……………………………….

If you have previously registered for any level of the Society's examinations, please give your candidate number (if known):

…………………………..

FEES

The composite fee for registration and enrolment is as follows.

Examinations to be taken

* Special rates are available for candidates in countries recognised by the Society as "Economically Developing Areas". Candidates who wish to claim these rates must check with the Society in advance whether their countries are so recognised.

See next page for methods of payment

All payments should be payable to The Royal Statistical Society.

Payment in the UK may be made by cheque, credit card (see below) or postal order. Payment from abroad may be made by sterling cheque drawn on a sterling currency account, sterling bank draft, credit card, postal order or international money order.

Credit card payment

I wish to pay by credit card (Visa/MasterCard/Maestro/American Express).

Please charge my account. My card number is:

Security code (For Visa/MasterCard/Maestro – last 3 digits of the number printed on signature strip on back. For AMEX – 4 digit code on front of card):

Valid from …….. / ……… Expiry date …….. / ………

Billing Address used by credit card company, if different from address on page 1 (must include postcode):

Payment via Invoice/Purchase Order

Please invoice me/my employer as follows:

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This form must be returned by post or e-mail with the correct remittance to

Professional Affairs and Examinations Manager

The Royal Statistical Society

12 Errol Street

London

EC1Y 8LX

UK

The opening date for registration and enrolment for the 2017 examinations is 1 October 2016.

The closing date is 1 March 2017.

Late entries will not be accepted. [But see page 10 of the general Guide to Examinations (Ex1).]

Your attention is drawn to the information in the general Guide to Examinations (Ex1) concerning withdrawal from the examinations.

The Society's telephone and fax numbers are

phone : 020 7614 3915

fax : 020 7614 3905

(for callers from overseas, the leading 0 is replaced by the international dialling code for the UK, usually +44).

The email address for all examinations matters is

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The information given on this form will be used by the Royal Statistical Society to process your application. If successful it will be retained and used by staff, officers and members in furtherance of the aims of the Royal Statistical Society and in accordance with the 1998 Data Protection Act.

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FOR OFFICE USE ONLY

Date received

Amount

Cash ref

Centre