Turn your printer on, and you may print out this document by hitting the Print button above, then simply fill in the form below, and post it to the address at the bottom of the page. Please print your details.
FRIENDS OF ERASMUS DARWIN HOUSE

Application for Membership
  
Full Name: Mr/Mrs/Miss/Dr . . . . . . . . . . . . . . . . . . . . . . . . . Block Capitals Please
Address: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
  . . . . . . . . . . . . . . . . . . . . . . . . . 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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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
85 Mildenhall, Tamworth, Staffs   B79 8RZ, England


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 him 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.


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