Herb Society Strategic Plan

I would like to be a Member of the Herb Society :

Please tick	Category	Details	Fee UK£
	Full Member Joint Member	UK and Channel Islands * or £25 if paying by direct debit 2 members from one UK/Channel Islands household	27.00* 37.00
	Senior Citizen	UK and Channel Islands	24.50
	Student	Full time student and whose course of studies is due to be completed by __________	24.50
	Overseas	Based outside the UK and Channel Islands	40.00
	Family	2 adults and up to two children	42.00

Title ___________________________

Name __________________________

Address ________________________________________________________________

_______________________________________________________________________

Post Code _____________Landline _________________Mobile____________________

Email __________________________________________________________________

PAYMENT CAN BE MADE BY CHEQUE, CREDIT OR DEBIT CARD:

Cheque

I enclose my subscription of £___________

I wish to pay by Credit/Debit Card (Visa/Mastercard)-please delete as necessary

Please debit the sum of £ __________ from my credit/debit card

Name on card ______________________________________

Card No. __________________________________________

Valid from: ________________Expiry date ________________

Security code (last 3 digits of number on reverse)____________

Signature ______________________________ Date _______

Where did you hear about the Herb Society?

__________________________________________________________________

Please return with payment to:

The Herb Society, Sulgrave Manor, PO Box 946, Northampton NN3 0BN

Data Protection Act 1998: Personal data collected on this form will only be used by the Herb Society and will not be disclosed to any external sources without your express written consent.

Application Form For Herb Society Membership

Please print and complete the form below

I would like to be a Member of the Herb Society :