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Membership Application Form

If you are a new member your application will need to be approved by The Society before it is activated.

Fields with a red asterisk * are required.

Membership Type
Annual Membership Please select a Membership type
	Ordinary Annual Member - £ 25.00
	Senior Annual Member (age 65+) - £ 18.00
	Family Annual Member(incl. spouse & children under 18) - £ 30.00
	Senior Family Annual Member - £ 20.50
	Library / Institutions - £ 30.00
	Students - £15.00
Annual Membership Options
Number of Years:
5 years membership available for 4.5 years subscription. New subscriptions received between October and December will be credited to the following year. PayPal Subscription - automatically pay your membership. Cancel anytime in PayPal.
Life Membership Please select a Membership type
	Aged 65 & under - £ 720.00
	Over 65 - £ 300.00
	SPECIAL GIFT CATEGORY Early Life Age 18 to 40 - £ 300.00

Your Contact Details
* First Name:
* Last Name:
* House Name / Flat Number:
* Street:

* Town / City:
* State / Province:
* Postcode:
* Country:
* Commissioner Area:
* Telephone Daytime:
Telephone Evening:
Fax:
* Email Address:
* Confirm Email Address:
* Password:

Your Preferences
Allow Commissioner to contact:	Yes: No: (only your Name, Telephone and Email will be shown)
Allow members to contact:	Yes: No: (only your Name, Telephone and Email will be shown)
Hide Telephone Number:	- tick box to hide your telephone number from other members
Hide Email Address:	- tick box to hide your email address from other members
Receive Emails from The Society:	Yes: No:
Receive Newsletters:	by Email: by Post: No:

Additional Information
How did you hear about us?: