Application Form to become a Member
or a Friend of Penkridge Civic Society
Print this form off
I wish to become a member/friend of Penkridge Civic Society
Name ...............................................................
Address.............................................................
.........................................................................
.........................................................................
..........................................................................
Telephone No: .....................................................
I have a particular interest in (e.g. local
history/genealogy/planning/conservation of buildings/trees) Application Form to become a Member
or a Friend of Penkridge Civic Society I wish to become a member/friend of Penkridge Civic Society Name
............................................................... Address............................................................. ......................................................................... ......................................................................... .......................................................................... Telephone No:
..................................................... I have a particular interest in (e.g. local
history/genealogy/planning/conservation of buildings/trees, etc.) ...................................................................................... ..................................................................................... .................................................................................... I enclose a cheque for £............... (made payable to
Penkridge Civic Society) Members' subscription £8 per year.
Friends' subscription
£5 per year. Please return this form with your cheque to: Penkridge Civic Society
Print this form off
c/o David Calcroft
The Cottage
Station Road
Penkridge
Stafford ST19 5AN
(Charity
No. 519869)