Part A: Membership Application Form

Please write clearly, preferably in Block Capitals (*please delete as appropriate)

TITLE (Mr Mrs Ms etc)

FORENAME/S

SURNAME

ADDRESS

POSTCODE

TELEPHONE NUMBER:

E-MAIL ADDRESS

Do you wish to join the free Society e-mail service?  

YES or NO:

(if YES please ensure your E mail address is shown above)

A. DATA PROTECTION ACT: I hereby give permission for:

(i).   My Membership and Family Interest details to be held on computer.

(ii). * The Society to pass these details on to other members (e.g. via the Members' Interests Booklet) or other interested parties (The Society undertakes not to pass on membership Information to any commercial undertaking or mailing lists)

B.  *[Only applicable to members able to attend monthly meetings] I also undertake to return, or renew any books, tapes, fiche or CDs borrowed from the library at the following meeting

PLEASE SIGN BELOW, deleting any of the above clauses you do NOT accept

Signed

Date

Note: For members joining after Oct 1st the subscription will run to 31st December of the following year

Payment made by: Cheque enclosed / Telephone/ Internet Banking/cash* (details below)

When completed and signed, please return form with subscription to Membership Sec:

Mrs Sheila Moulton, MNFHS, 14 Elizabeth Avenue, Fakenham,NR21 8JU
Tel
: 01328 855895  Email: mnfhs.m.sec@btinternet.com
Subscription Rates:
£8.00 per year individual [OVERSEAS Newsletter by e-mail also £8. Surface mail rate £12.50 (£11.0 Europe)]
£11.00 per year for a couple living at the same address

Cheques/Postal Orders should be crossed and made payable to:   
Mid Norfolk Family History Society

(overseas cheques must be in pounds sterling and drawn on a UK Clearing Bank)

Telephone or Internet payments should be made to:
HSBC, 1 Market Place, Dereham, NR19 1DY

Account Name: Mid Norfolk Family History Society
Account No: 71168231   Sort Code: 40-20-08

(click here to open the Members Interests Form.)