Membership Application Form

Registered Charity No. 273726
VAT Reg: 837 1655 13

I/We wish to become a member(s) of the Sussex Family History Group and

enclose the appropriate annual subscription.

BLOCK CAPITALS PLEASE

Mr/Mrs/Miss/Title........................................................................................................

Surname......................................................If married, maiden name .......................

Forename(s)...............................................................................................................

Address.......................................................................................................................

Town...........................................................................................................................

County/State/Province ...............................................................................................

Post/ZIP Code ................................................Country .............................................

Telephone number ........................

email address (if applicable)......................................................................................

MEMBERSHIP required:

Ordinary / Joint (2 in household) / Junior (U18) / Subscribing member organisation (Please delete as appropriate)

SUM ENCLOSED: £ ........................................ (sterling cheque)

OR

Visa/MasterCard No: ............................................Expiry date: ...............................

Name on Card ............................................ CVC (digits from back of card):.............

Address of card holder if not as above .....................................................................

..................................................................................................................................

SIGNATURE: ..........................................................................................................

DATE.................................. (Payment after October 1 also covers following year.)

Send to: John Commins, 11 Wellwood Close, Horsham, West Sussex, RH13 6AL, ENGLAND