Please fill in this form and print using the button at the bottom of the page and send to:
The Country Doctors Association
Highcliffe
Shilton Road
Barwell
Leicester,  LE9 8BN

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Name
Practice Address
 
 
 
Postcode
Tel
Fax
If Staff Please give job title
Home Address
 
 
 
Postcode
Tel
e-mail

I enclose the Annual Subscription of £30 (doctor) or £20 (staff) made payable to the Country Doctors Association.
                  

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