ࡱ> MOLo  bjbj 4$ڗzfڗzf  8,<<RRRRAAA6888888$a"f\AAAAA\RRqARRR6A6R@Vwkw("0,}"|}"}"@AAAAAAA\\7|AAAAAAA}"AAAAAAAAA X N:  Membership application 2019/20 Annual membership 12.00 Return form to Anusha Sri-Pathmanathan, 307 ACE Extension, South Kensington, Email:  HYPERLINK "mailto:a.sri-pathmanathan@imperial.ac.uk" a.sri-pathmanathan@imperial.ac.uk Name  Contact Details Email  Address  Telephone Number  Status (please delete as appropriate) Employee/retired employee/partner/other (please specify): Payment Details Bank Transfer IC Womens ClubAccount Sort Code: 51-50-01; Account No. 00618187 (Cheques also acceptable made payable to IC Womens Club) Data Protection Act I am willing to permit my name to be included and shared in the ICWC and related 51Թ College databases and email lists. 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