Hampshire Group : Membership Application

I wish to apply for membership in the following category (please tick):

   Individual  (£5 a year)

   Joint  (£8 a year, for 2 people living at the same address)

I enclose a cheque / bankers order (please delete as appropriate)

PLEASE COMPLETE IN BLOCK CAPITALS

Name:

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(please state Mr/Mrs/Miss/Ms etc)

Address:

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Postcode:

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

E-mail:

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Date:

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Please send completed form to Alan Leagas, 18 Vitre Gardens, Lymington, Hampshire SO41 3NA, including either a cheque made payable to The Jane Austen Hampshire Group or a completed Bankers Order form.