Membership Form

Silksworth History & Heritage Group

Membership Application Form

(Please print out this form then complete it and forward it with your remittance.)

I/We wish to apply for membership to Silksworth History & Heritage Group and enclose my/our cheque to the value of £............... made payable to Silksworth History & Heritage Group.

Title: ....................................................................

Name: ....................................................................

Postal Address: ....................................................................

Town: ....................................................................

County: ....................................................................

Country: ....................................................................

Post Code: ..............................

E-mail: ....................................................................

Tel. No: ....................................................................

Please tell us of your particular interest in Silksworth .................................................................................

Membership: £0.50 (renewable in April)

Please forward your completed Membership Application Form(s) to:

  The Membership Secretary
  Silksworth History & Heritage Group
  38 Somerset Cottages
  Silksworth
  Tyne & Wear
  SR3 1BX

Please Note:

The Society holds its membership details on computer. We would appreciate your permission to store your membership details on our system. The committee guarantees that the list will contain only those details entered on your completed application form. Your membership details will not be passed on, in any shape or form, to any other organisation. As a formality, please complete

I/We hereby give permission to SH&HG to my/our membership details on an electronic mailing system.

Signature: ....................................................................

Block Capitals: ....................................................................

Date: ..............................