Name _________________ Surname _________________ Title: Mr./Ms/Dr./________
Sex: M/F Date of birth: ____/____/____/
Address: ________________________________________________________________
________________________________________________________________________
Tel: No.: ______________ e-mail addr.: _______________ Fax No: ______________
Qualifications and Date of qualifying: _________________________________________
________________________________________________________________________
Job Title: ________________ Work Tel No. : ______________
Fax No: ____________
Place of Work: ___________________________________________________________
__________________
_____________________
Date of Membership
Member’s Signature
Please give any suggestions which you deem necessary for the development
of the MAGG
Suggestions for Action/Activities by MAGG: ___________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Comments : _____________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
If you are interested in becoming a member, print the above for and
send it to the address below.
If you are paying by cheque or postal order, please address them to:
The Treasurer, Maltese Association of Gerontology and Geriatrics, c/o
Institute of Gerontology, University of Malta, Msida, Malta