|
I hereby apply to be admitted
to Membership of the Herb Society as
| Please tick |
Category |
Details |
Fee UK£ |
| |
Ordinary Member |
UK and Channel Islands |
25.00 |
| |
Senior Citizen Member |
UK and Channel Islands |
22.50 |
| |
Student Member |
Full time student and whose course of studies is
due to be competed by __________ |
22.50 |
| |
Overseas Member |
Based outside the UK and Channel Islands |
38.00 |
| |
Associate Member |
Comprises the Member, partner and up to two children |
40.00 |
Cheques and Postal Orders
I enclose my initial subscription of £___________
Standing Order Instruction
To the ______________ Bank _____________________________________
Branch My account name______________________________________________
No. __________________________ Sort code _________________________
Please pay the HSBC (40-33-33) 19 Midsummer Place Milton
Keynes PO Box 1888 Coventry CV3 2WN for the credit of
The Herb Society account no. 01403702 the sum of £ ______
on
1st __________ and on 1st ______ in each following year.
Credit Card (Visa, Mastercard, or Eurocard) - sorry,
but we cannot accept debit cards
Please debit the sum of £ __________ from my credit card.
Name on card _____________________ Expiry date _______________________
Type of card ______________________ Card No. _______________________
Signature ______________________ Date _______________________
My Details
Name __________________________ Address ________________________________________________________________
________________________________________________________________
Post Code __________________________ Tel. No. ________________________
Email __________________________
Where did you hear about the Herb Society? __________________________________________________________________
Please Return the completed form with your payment
to: The Herb Society, Sulgrave Manor, Sulgrave, Banbury, OX17 2SD
Data Protection Act 1998: Personal data
collected on this form will only be used for the purpose
of the Herb Society administration and will not be disclosed
to any external sources without your express written consent.
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