Membership Application Form
(Revised 31 May 2006)

Please complete using BLOCK CAPITALS and mail or fax to:

Manchester & Lancashire FHS Membership Department,
Clayton House, 59 Piccadilly, Manchester, M1 2AQ, UK
Tel. (+44) 0161 236 9750, Fax. (+44) 0161 237 3812
(Drop the first 0 if dialling from outside the UK)
e-mail office@mlfhs.org.uk

 

ANNUAL SUBSCRIPTION RATES (Please tick as appropriate)
U.K. Individual Membership UK £15.00
Family membership £18.00
Europe and Rest of the World Membership £15.00
There is also an additional joining fee of £3. This should be added to the amount above.
This is not payable at the annual renewal
Title (delete as appropriate): Mr/Mrs/Miss/Ms/Dr/Prof
Name  :  
Name 2 (Family Membership only):  
Address:  
   
Post/Zip:  
Tel. No.:  
Fax No.:  
E-mail Address:  
*Please delete where appropriate.
I am paying by *cash *postal order *cheque No. _________________  the sum of £________
Payment should be made in pounds sterling and cheques made out to Manchester & Lancashire Family History Society
I am paying by *VISA *MASTERCARD *Please delete where appropriate.
Payment will be charged in pounds sterling
Card Number:  |__|__|__|__| |__|__|__|__| |__|__|__|__| |__|__|__|__|
Expiry Date: __________/___________
Debit Cards Only
Issue Number: ____		 Start Date: __________/___________
Signature
(essential for credit card payment)		  
Membership of Manchester & Lancashire FHS automatically gives you full membership of all Branches of the society. Please tick your areas of particular interest.
Anglo-Scots ____, Bolton ____, Oldham ____, Irish Ancestry ____

Registered as a charity No. 515599 - V.A.T. No. 508 5873 22