BMSGH Membership Application Form

MEMBERSHIP APPLICATION FORM Date......................................20................. To:The Birmingham and Midland Society for Genealogy and Heraldry 5 Sanderling Court, Kidderminster, Worcs DY10 4TS I hereby apply to become a member of the above named Society. I wish to pay by cheque /credit card (please delete as appropriate). My annual subscription of : £14.50 (sole) £20.00 (joint) £7.00 (associate-under 21) Plus airmail £4.00 (if applicable) is enclosed for the calendar year 20.... Cheques payable to BMSGH. Credit Card Payments available via: Mastercard/ Visa/ Delta/ Electron/ Solo/ JCB/ Switch We cannot accept American Express at the moment. Card Number................................................................................... Start Date......................................Expiry Date................................. Name on Card.................................................................................. Issue Number (if applicable).............................................................. Security Code (last 3 figures on back of card) .................................. TITLE Mr/Mrs/Miss/Dr/.................. SURNAME ......................................... FORENAMES............................................................................................. JOINT MEMBER'S NAME........................................................................... (Must be at same address) ADDRESS.................................................................................................................. PostCode ....................... Telephone No ......................... Fax No ....................... Email address............................................................................. Date of Birth (if under 21).............................. Signed.......................................
How did you hear of this Society ? (Please give details if possible.)
Magazine	......	Family History Course at	...............................................
Branch	......	Family History Fair at	...............................................
Record Office	......	Web Site	...............................................
Public Library	......	Other	...............................................
Rejoining (Please state previous Membership No and earlier address if any)
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