Application Form
To join the Friends of Darwin House print out this document then simply fill in the form below and post it to the address at the bottom of the page. Please print your details clearly.
FRIENDS OF ERASMUS DARWIN HOUSE
Application for Membership
| Full Name: | Mr/Mrs/Miss/Dr . . . . . . . . . . . . . . . . . . . . . . . . . Block Capitals Please |
| Address: | . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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| . . . . . . . . . . . . . . . . . . . . . . . . . Post Code: . . . . . . . . . . . | |
| Telephone No: | Include Country Code if outside UK . . . . . . . . . . . . . . . . . . . . . . . . |
| Signature: | . . . . . . . . . . . . . . . . . . . . . . . . . Date: . . . . . . . . . . . . . . . |
| Please make cheques payable to the Friends of the Erasmus Darwin House | |
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Bankers Order
| To: The Manager | . . . . . . . . . . . . . . . . . . . . . . . Bank Plc |
| Full Address: | . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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| Please pay to HSBC plc., 49 Market Street, Lichfield WS13 6LB (Sort code: 40-28-18) Account Number 11489267 for the credit of the Friends of the Erasmus Darwin House the sum of :- | |
| £ . . . . . . £ . . . . . . . . . . . . . . . . . . . . . . . annually, starting on the . . . . . . . [figures]  [amount in words][date]until further notice from me |
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| Bank Sort Code: | . . . . . . . . . . . . . . . . . . . |
| Debit my account number: | . . . . . . . . . . . . . . . . . . . |
| Signature: | . . . . . . . . . . . . . . . . . . . |
| Account Name: | . . . . . . . . . . . . . . . . . . . |
| NB: This cancells all previous Bankers Orders in favour of the Friends of the Erasmus Darwin House. | |
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FRIENDS OF ERASMUS DARWIN HOUSE
Friends of Erasmus Darwin House contribute greatly to the upkeep and running of the House.
Friends receive:
- Regular newsletters
- FREE entry into the House
- Preferential rates for the hire of the House and seminar room
- An invitation to an evening once a year with a guest speaker
Membership Subscriptions (Minimum)
Ordinary Members £13.00 per annum
Concessions £10.00 per annum
Joint Membership £20.00 per annum
Joint Concessions £18.00 per annum
10 year Membership £100.00
Joint 10 year Membership £150.00
Life Membership £250.00
Joint Life Membership £400.00
The subscription rates are a suggested minima, if you can afford to give more, we would be most grateful.
I/We wish to become an
*Ordinary/Joint Membership/10 Year Membership/ Joint 10 year Membership/ Life Membership/ Joint Life Member ….. of the Friends of Erasmus Darwin House.
*(Delete as appropriate).
How to become a Friend
Print off and complete the Application Form and send it with your cheque or a completed bankers order from as directed to the Secretary (address below).
Post to:
The Secretary, Friends of the Erasmus Darwin House
c/o Erasmus Darwin House, Beacon St, Lichfield, Staffordshire WS13 7AD
You may wish to pay any future Membership Subscriptions by Standing Order. This will be welcomed by The Friends of Erasmus Darwin House. If you would like the Treasurer to send you a Standing Order Form please write to her at the address provided.
The Treasurer regrets to inform you that The Friends of Erasmus Darwin House cannot accept payment for subscriptions made by debit or credit cards.