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APPLICATION FOR ELECTION TO (VOTING) ASSOCIATESHIP

BLOCK CAPITALS PLEASE

I …………………………………………………………………………………………………………………………

(Mr/Mrs/Miss/Ms/Dr etc. and name in full)

of ……………………………………………………………………………………………………………………….

(Full address with postcode)

………………………………………………………………………………………………………………………….

………………………………………….. Telephone number …………………………….

hereby apply for election as Voting Associate of the Radionic Association.

Honours/decorations/degrees/professional qualifications ……………………………………………………......

………………………………………………………………………………………………………………………….

Nationality ………………………….. Date of birth …………………………………….

Present occupation and appointment ……………………………………………………………………………......

………………………………………………………………………………………………………………………….

Introduced by (if applicable) ……………………………………………………………………………………….....

NOTE: Article 10 provides that an Associate shall be a person who, being not less than eighteen years of age, shall satisfy the Council of bona fide interest in Radionics and shall be desirous of supporting and promoting the objectives of the Association. Associates are not permitted to use the name of, or the fact of their membership of, the Association for any professional purpose whatsoever. Voting Associates are not permitted to hold themselves out to the public as Radionic Practitioners.

I HEREBY DECLARE that I have read the above note and am willing on election to be bound by the Memorandum and Articles of Association and any Bye-laws, Rules or Regulations of The Radionic Association now or at any time hereafter in force.

SIGNATURE ……………………………………………………………….. DATE …………………………