Interconnections Multi-Disciplinary Information Service

IQJ - Subscribe - Pay by Cheque

Please fill in the following form to pay for an annual subscription by cheque or BACS.

Contact Name:
Role:
Organisation:
Contact Email:
Contact Telephone:
Please select the type of subscription you require:
Individual Annual Subscription (UK) @ £15 +VAT Corporate Annual Subscription (UK) @ £250 +VAT Individual Annual Subscription (INTERNATIONAL) @ £30 +VAT Corporate Annual Subscription (INTERNATIONAL) @ £300 +VAT
Please enter the details for your invoice:
Name or Organisation:
Address Line 1:
Address Line 2:
Address Line 3:
Postcode: