Membership Application (by cheque)

Membership Application (cheque payment)

Northamptonshire Family History Society
I/We apply for membership of Northamptonshire Family History Society
Name*

TitleFirst NameLast Name
What do you like to be known as?
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Home Phone
Please enter a valid phone number.
Mobile
Please enter a valid phone number.
How did you hear about the Society?*
Other, please specify*
Your age
e-news - would you like to receive our monthly e-newsletter?*

YesNo
'Footprints' - how would you like to receive our quarterly journal?*

Printede-mail
Consent to send PID outside the EU
I consent to my personally identifiable data (PID) being published in the Society journal 'Footprints' and being sent outside the EU*

YesNo
Please use this space to note any restrictions on any element of your PID
Member's Name Interests

You may submit your name interests by entering details below
Would you like your Northants (and neighbouring counties) name interests uploaded to the Society web site?

YesNo
Additional Information/Remarks
Tick this box if you would like a record of your form entries e-mailed to you.
Signature
(just type in your name)
Date

DayMonthYear
Pressing 'Submit' will send your application to the Membership Secretary. Simply post your cheque (name and address on reverse) or e-mail proof of BACS payment to: -

Membership Secretary
52 Russell Way
HIGHAM FERRERS
Northants NN10 8EJ

membership@northants-fhs.org
Should be Empty:

Membership Application (cheque payment)

Consent to send PID outside the EU

Member's Name Interests