Barnes Literary Society

MEMBERSHIP APPLICATION/RENEWAL 2010/11
(PLEASE COMPLETE IN BLOCK LETTERS)

Individual membership: £25 per annum

Joint membership:       £40 per annum

Subscriptions fall due annually on 30th September

Membership:     single             joint

Method of Payment:
            Standing order       Cheque*

*cheques to be made payable to Barnes Literary Society

Membership number (if known): ...................................

First Name(s) & Title(s): ..............................................

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Family Name(s) ............................................................

Address: .......................................................................

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Post Code: .........................

Phone Number: .............................................................

Email Address: ..............................................................

Signature: .....................................................................

Date: ................................................................ 2010/11