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THE FAMILY HISTORY SOCIETY OF CHESHIRE

MEMBERSHIP APPLICATION FORM

Enrolment Secretary : Mrs Heather Booth
3 Bowland Road, Woodley, Stockport, SK6 1LJ

Subscription Rates

(please tick as appropriate)

Plus an initial Registration Fee of £2.00 per household.

The membership year runs from 1st July to 30th June. Note that membership starts from the day your form is received, and cannot be post-dated. Please allow up to 14 days for delivery of your membership pack.

   NAME(S) (Mr/Mrs/Miss) .................................................

   ADDRESS ...............................................................

   ..............................  POST/ZIP CODE .........................

   TELEPHONE No. ................  E-MAIL ADDRESS ........................

   DATE .........................  SIGNATURE .............................

   I/We enclose payment of £ .......... (including £2.00 Registration Fee)

All cheques, etc. should be made payable to F. H. S. of Cheshire, and sent with this form to the Enrolment Secretary at the address shown at the top of this page. 

OR Please debit my debit/credit card                               NAME_________________________________          
Card Number _______________________________          Start Date __/__   Exp Date __/__  Issue No ____
 
SecurityNo.  ___________________       (Last 3 digits on reverse of card)

Visa/Mastercard/Switch/Other ___________________       (Please delete as appropriate.)

Members may choose to affiliate themselves to one of our local groups, or remain unattached. Please tick as appropriate: 

Alsager     [  ]   Chester        [  ]   Nantwich        [  ]   Wallasey    [  ]
Altrincham  [  ]   Congleton      [  ]   Northwich       [  ]   West Kirby  [  ]
Bebington   [  ]   Crewe          [  ]   Runcorn         [  ]                      
Birkenhead  [  ]   Dukinfield     [  ]   Stockton Heath  [  ]   Unattached  [  ]
Bramhall    [  ]   Macclesfield   [  ]   Tarporley       [  ]