Scottish Association of Chaplains in Healthcare, Application Form

Please print this form, fill it in and send it off with the appropriate fee.

SACH Application Form

Please complete in BLOCK CAPITALS

Name _________________________________________________________

Mailing Address:
______________________________________________________________

______________________________________________________________

Post Code __________________________

Home Telephone __________________________

Hospital/Hospice Name and Address
________________________________________________________________

________________________________________________________________

Hospital Telephone ___________________

Direct Line _________________________

Fax Number ________________________

E-mail ____________________________

Religion ___________________________

Denomination _______________________

Membership Category (Please tick)

Please make cheques payable to "SACH" and forward with the completed Application Form to:

Monica Stewart
Chaplains' Office, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN