Membership Form

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Step 1 | Create an Account

Title *

First name *

Last name *

Your Email Address *

Verify Email Address *

Password

Confirm Password

8 characters
One number
One Capital alphabet
One small alphabet
One special character
Confirm Password should match Password

Membership Type*

Standard Membership ( £90/yr)
Trainee Membership ( £45/yr)
Radiographer Membership ( £45/yr)
Registered User

Step 2 | Personal Details

Title *

First Name *

Last Name *

Address Line 1

Address Line 2

City

County/State

Postal/Zip Code

Country *

Gender *

Male
Female
Prefer Not to Say

Year of Birth *

Telephone No.

Mobile No. *

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Step 3 | Area of Practice

Job Title *

Hospital/Institution

Please select as many areas of interests applies below

Modality Interest *

Subspecialty Interest *

Anatomical Interest *

Step 4 | Payment Information

Please use following bank transfer details to complete your payment.

Payment in GBP £:
Bank Address: 1 Churchill Place, Canary Wharf, London, E14 5HP, United Kingdom
Account Name: International Cancer Imaging Society (ICIS)
Account Number: 90164879
Sort Code: 20-69-15
IBAN: GB82 BUKB 2069 1590 1648 79
SWIFT: BUKBGB22

Payment in Euros €:
Bank Address: Barclays, Leicester LE87 2BB
Account Name: International Cancer Eur
Account Number: 83157599
Sort Code: 20-69-15
IBAN: GB82 BUKB 2069 1583 1575 99
SWIFT: BUKBGB22

Please note bank/wire transfers payments are a slow process and it may take up to three business days after you'll send your wire transfer/ bank payment. We strongly suggest to use Credit Card or PayPal if you wish to activate your ICIS membership immediately.

Click here to download Bank Transfer details in PDF.

Please make payment at the confirmation of this registration. ICIS admin will reach out to you if they'll need any additional details.

Billing Address 1

Billing Address 2

City

County/State *

Postal/Zip Code

Country *

Membership Form

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Summary

Membership Price £90

Sub Total£90

Total Due£90