THE JOHN HAMPDEN SOCIETY

MEMBERSHIP APPLICATION FORM

To print off this form click here.

I/We wish to apply for membership of The John Hampden Society.

Surname(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Forename(s) . . . . . . . . . . . . . . . . . . . . . . .
Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Postcode . . . . . . . . . . . . . . . . . . . . . .
Telephone No (include STD code). . . . . . . . . . . . . . . . . . . . . . . . Signed . . . . . . . . . . . . . . . . . . . . . .

British Isles Overseas
Adult membership .................................................. £10.00 £12.50    
Under-18 membership (Date of birth.........................) £5.00 £7.00    
Joint membership (give both names) ............................ £15.00 £18.00    
Family membership (give all names) .............................. £24.00 £30.00    

I/We enclose a cheque/postal order for £ .......... as a donation to the society (optional)
(please tick the appropriate box)
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

STANDING ORDER AUTHORITY

To:-The Manager              
 
 
 
 
Please write the name and full
postal address of your bank in this box
Name(s) of account holder(s) . . . . . . . . . . . . . . . . . . .
Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . Postcode . . . . . . . . . . .

Signature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

 

Account No.                                             
Bank sort code             -           -          
Please insert your bank account details in this box

I/We instruct you to pay the above account the sum of £ . . . . . . . . (in figures) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (in words) now and on the 1st of January annually until further notice to THE JOHN HAMPDEN SOCIETY (Sort code/account no. 30-91-60 - 03935099 ) at Lloyds TSB Bank plc, 49 High Street, CANTERBURY, Kent CT1 2SE, quoting reference number . . . . . . . . .(for official use only)

(If completing this mandate as a new member, please send a remittance for the first year’s membership and delete the words ‘now and’ above. The standing order will then come into effect on the 1st of January following.)

If you are a UK taxpayer please complete
the Society's gift-aid form
and return it to us with your application form.

Please send the completed form(s) and any additional remittance to:-

The Membership Secretary
The John Hampden Society
Patrochal, Barteliver Hill
Grampound
TRURO, Cornwall TR2 4SA.
E-mail: ...@johnhampden.org

Please enclose two second-class stamps for the return of your membership card.
(not applicable to overseas members)


Home | About John Hampden | About the Society | The Society's activities | Booklist | Archives
Documents | Join the Society | Diary of events | Links to other sites | Newsletter | Guestbook | Contact us