The Colonel Stephens Society

MEMBERSHIP APPLICATION

Please use BLOCK CAPITALS for your name and address,

and delete at * where appropriate

Name  ………………………………………………………............................................

Address  ………………………………………………...................................................

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

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

Postcode  ……………………………………...............................................................

Telephone   …………………………….......................................................................

    and/or

Email   ……………………………………....................................................................

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 passed to other members

I enclose a cheque for £13 for UK members / £15 for joint UK Members living at the same address (1 Colonel) / £20 for overseas members (airmail).  (Please contact membership secretary for details if you wish to pay via BACS)

Signature…………………………………………………......................................             

Date…………………………………….........

New members will receive the most recent issue of ‘The Colonel’ plus three recent back numbers, along with their membership card.

Please print this form and send it, completed 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

If you would prefer to pay by BACS please contact the Membership Secretary for details:-