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 2017

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 enclose 10 for individual membership  
We enclose 15 for joint membership    
I/we have set up a Standing Order ∗    


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, 6 Glendower Road, SW14 8NY
020 8878 0629

∗ To set up a Standing Order you can use the attached form.

Registered Charity No. 292918