Print this page and complete in Block Capitals. Send to the address given below together with the relevant fee.


                      Application Form
To
The Membership Secretary
London Westminster & Middlesex FHS
2 Canonbury Cottages, Churchbury Lane,
Enfield, Middlesex EN1 3LR,
UK.

    

I apply for membership of the Society and enclose a cheque for UK £12.00 (Twelve Pounds ) UK Sterling cheque or money order drawn on a London Bank) made payable to London Westminster & Middlesex FHS
Name (Mr Mrs Miss Ms or Dr) 

 

Address  
 
 
 
 		  
Postcode    
Country    
Telephone    
E-mail    
Signed    

For office use only
Received:
 Bank:
Cheque No:
 Branch:
Dated:
 Amount:
Membership No:                                                       Renewal Date:


N.B If an immediate acknowledgement is required please send a self addressed stamped postcard. Allow 28 days for members pack.