Kent Branch : 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     £10

    Household membership   £15

(please tick as applicable)

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

Signature:

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

Forms should be sent to the Membership Secretary, including a cheque made payable to The Jane Austen Society (Kent Branch) or a completed Bankers Order form (displayed via the above link).

Membership Secretary

Elizabeth Earl
107 The Street
Mereworth
Maidstone
Kent ME13 5LU

E-mail: theearls@mereworth.fsnet.co.uk