THE JOHN HAMPDEN SOCIETY

MEMBERSHIP APPLICATION FORM

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

Surname(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Forename(s) . . . . . . . . . . . . . . . . . . . . . . .
Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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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