Baldock's Mill engraving

 

BOURNE CIVIC SOCIETY
Registered with the Civic Trust

President: Baroness Willoughby de'Eresby

 

Application for membership of the society

I/We wish  to join the Bourne Civic Society in the category ticked below:

□ SINGLE: £6.00      □ JOINT: £8.00     □ FAMILY*: £10.00
 *Family of two adults and their children under 16.

                          

Please find enclosed the sum of £_____ cash/cheque No: _____

 

Title: Prof/Dr/Mr/Mrs/Ms/Miss (delete as necessary)

BLOCK LETTERS PLEASE
 

Surname: _________________________________________
 

Forename(s): ______________________________________

 

Address: __________________________________________

 

________________________________Post Code: _________

 

Telephone: _______________________Email: ____________

 

Introduced by or in response to: _______________________

 

Date: _________________  Signature: __________________

 

The society's year runs from 1st January to 31st December.
Please print this form, complete it and post with the
appropriate subscription fee to:

The Membership Secretary, Bourne Civic Society, Baldock's Mill,
21 South Street, Bourne, Lincolnshire PE10 9LY.
 

Registered charity No 512420