NALH - membership form for Societies

Please complete the form. Print it out and send it with your subscription to the Treasurer.

Items marked * are required.

Name of Organisation: *

Name of Contact: *

Position: *

Address 1: *

Address 2:

Address 3:

Town: *

County:

Post Code: *

Country:

Telephone No: Note: This is for committee use only.

e-mail address:

The following information us not essential, but would be useful for our records.

Year society founded:

Number of members:

Annual Subscription:

Publications:
see Note 1.

Meetings:
see Note 2.

Notes:
1. Please include any regular items such as newsletters as well as occasional items such as booklets, guides, etc.
2. Please indicate frequency, the usual day / month and the type, e.g. lectures, study groups, outings, etc.

continued ...

Major subjects of interest and research:

Website address:

Talks given:

Projects:
(past, current or planned)

Continue on a separate sheet if necessary

I enclose a cheque for £ payable to:

Northamptonshire Association for Local History (NALH)

The Committee have considered the information about the Data Protection Act and have no objection to the details above being circulated to other members of the Association

Signature: Date:

Send the completed form together with your remittance to:

The Treasurer,
Northamptonshire Association for Local History, 6 Bakers Lane, Norton, Daventry, NN11 2EL.

Return to the Membership page or to the Home page.

Northamptonshire Association for Local History

Application Form for Society Membership