Colonel Stephens Society

MEMBERSHIP APPLICATION

Please use BLOCK CAPITALS for your name and address, and delete at * where appropriate

NAME: ………………………………………………………………………………………………………………

ADDRESS..................................................................................................................................................................

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......................................................................................................................................................................................

………………………………………………………………………………………………………………………..

POST CODE: …………………………

PHONE (optional)…………………………………E-MAIL (optional)……………………………………………….

The Society maintains a record of members and their names and addresses on computer to produce the

mailing labels for the society's journal and for the membership secretary to manage renewals. Details of

a member are passed to another member only with prior agreement.

I do/do not* agree to my details being included in any listing of members circulated with the society's journal.

I enclose a cheque for £10.00 (UK) £15.00 (Overseas Airmail only) £12.00 (joint UK same address, one Colonel)* made payable to

The Colonel Stephens Society.

Signature ………………………………….                       Date…………………………………… 

Please return this form, with cheque, to:

Sheena Baylis

10 Cedar Court,

Farrand Road,

Hedon.

East Riding of Yorkshire

HU12 8XL

01482 897645

Email css@thetrackside.karoo.co.uk