Kent Branch of the Jane Austen Society


Membership Application



PLEASE COMPLETE IN BLOCK CAPITALS

Name:

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

Address:

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Postcode:

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Telephone:

........................................   Mobile:............................................

E-mail:

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Individual membership     £12          £11 if receiving newsletter by e-mail  

Household membership   £18          £17 if receiving newsletter by e-mail  

(please tick as applicable)


I wish to pay by cheque / bankers order / electronic banking (please delete as appropriate)

Pay by electronic transfer as follows:

Bank Account #:   02002974

Sort Code:            30-90-28

Reference:            YOUR NAME


In addition, if you wish to make a Gift Aid donation, please complete and return the form displayed via the following link: Gift Aid


Signature:

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Date:

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E-mail this form to: Samantha Ford, Membership Secretary at: samanthaford180@virginmedia.com

Or: Send by post to Samantha Ford, Membership Secretary, 26 Park Crescent, Chatham, Kent ME4 6NR.

Please include a cheque made payable to The Jane Austen Society (Kent Branch), or a completed Bankers Order Form.