Over 30 years
of quality
local history
publishing...

THE DERBYSHIRE RECORD SOCIETY :: 9 OWEN FALLS AVENUE :: CHESTERFIELD :: S41 0FR

MEMBERSHIP APPLICATION

 

PRINTER-FRIENDLY MEMBERSHIP FORM

Simply print out the form and send with your cheque or standing order to the Society's Treasurer: Dr David Edwards, 57 New Road, Wingerworth, Chesterfield S42 6UJ.

Please enrol me as a Life / Annual member of the Derbyshire Record Society. I enclose a cheque for £75.00 / £5.00 payable to the 'Derbyshire Record Society'.

Prospective institutional members are asked to note that they may only apply for Life Membership as we are unable to invoice annually.

Name .............................................................................................................

Address ..........................................................................................................

Town ..........................................................................................................

Postcode...............................................

Alternatively, please complete the Standing Order below and return it to the Record Society Treasurer - not directly to your bank - at the above address.

-------------------------------------------------------------------------------------------------

Banker's Standing Order for Membership of the Derbyshire Record Society

Name of Bank ...................................................................................................

Branch Name ...................................................................................................

Branch Address ...............................................................................................

Name of Account ..............................................................................................

Account No ............................................................

Sort Code ....... - ....... - .......

Please pay now and annually on 9th September until further notice the sum of Five Pounds (£5.00) to the credit of the Derbyshire Record Society at Lloyds Bank PLC, Cardiff Branch, 27 High Street, Cardiff CF1 1QZ. Account No 0280898. Sort code 30-91-63.

Signed...............................................................

Name.................................................................

Date........................

Note to paying bank: Please use member's name and initials as a reference when setting up standing order.