Membership Form

Name*

First Last

Name of second member

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Membership Type*

Is this a renewal?*

Yes
No

Membership Number*

Additional Donation?

*

I confirm that I (or we) do not object to data relating to me (or us) being held on computer or paper file by the Society or information being disclosed to Members of the Society as part of the Membership Services.

I am a UK taxpayer, have paid tax sufficient to cover my subscription/donation, and wish the Society to reclaim tax under the GiftAid scheme

Message?

Where did you hear of the society?

How would you like us to communicate with you?

Email
Phone

By joining the Society you accept that we will communicate with you by post. Please tick if you would also like to receive information by email or phone:

Joint member - how would you like us to communicate with you?

Email
Phone

By joining the Society you accept that we will communicate with you by post. Please tick if you would also like to receive information by email or phone:

Name

This field is for validation purposes and should be left unchanged.

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