MEMBERSHIP REGISTRATION FORM

Please tick the required membership option(s). Junior membership can be held on its own or with individual or joint membership(*)

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If you are registering for joint or junior membership, please note that the Society keeps in direct email contact with just one member of the household. Please enter the nominated person's details below.
Title (Mr, Miss, Dr etc)(*)
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Full Name(*)
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Email address(*)
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For joint memberships give the name of the second member
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Please list any junior members here
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What is the total amount you will be paying?
Individual membership £12
Joint membership £18
Junior membership £6(*)
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Address 1(*)
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Address 2(*)
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Address 3
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Address 4
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Postcode or Zip(*)
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Country(*)
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Telephone(*)
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Our website contains a list of members, together with an idea of their general location (eg Herefordshire UK or Texas USA). Most entries also include an idea of the member's particular historical interests. To comply with UK data protection law, we need your permission before including your name.
May we include your name and general location?(*)
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Please tell us about any special interest you have in the Mortimers or medieval history
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How did you hear about the Society?
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Gift Aid - UK Taxpayers only
I wish to Gift Aid all donations made in 2018 and in the future to the Mortimer History Society (registered charity 1171392), I am a UK taxpayer and understand that if I pay less Income Tax or Capital Gains Tax than the amount of Gift Aid claimed on all my donations in that year, it is my responsibility to pay the difference.(*)

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How do you intend to pay your subscription?(*)

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