Barnes and Mortlake History Society

Membership Application Form

Either complete the form on line and print off, or print off first and fill in.

Annual Subscription for 2008-09 (Join now and your membership runs until 31 December 2009)

Individual: £10 per year

Joint: £15 per year (two people at the same address, receiving one copy of the newsletter).


I/We wish to join the Barnes & Mortlake History Society.     I/We enclose £


Name  

Address


Signature .......................................


Date

Phone Number

E-mail address


Gift Aid - make your subscription worth 28% more ! (Please tick this box)

I would like the Barnes and Mortlake History Society to reclaim Gift Aid on any membership subscriptions I have made over the last six years and in the future until I notify you otherwise. I confirm that I have paid an amount of UK income or capital gains tax equal to any tax reclaimed and I will notify you if my circumstances change.

Please send the completed form with a cheque to:

The Membership Secretary
Barnes & Mortlake History Society
8 River House
23 The Terrace
Barnes
SW13 ONR

Registered Charity No. 292918