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
By providing your e-mail address you consent to us contacting you by e-mail.
Home Phone
Please enter a valid phone number.Format: 00000 000000.
Mobile
Please enter a valid phone number.Format: 00000 000000.
How did you hear about the Society?
Other, please specify
Your age
e-news - would you like to receive our monthly e-newsletter?
'Footprints' - how would you like to receive our quarterly journal?
Consent to send PID outside the EU

Our Footprints journal is sent to members both in the UK and overseas and new members’ personal data published therein are limited to member number, name, county and country (if outside the UK). Answer “No” only if you do not wish said data to be published.
I consent to my personally identifiable data (PID) being published in the Society journal 'Footprints' and being sent outside the EU
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?
Additional Information/Remarks
Signature
(just type in your name)
Date

DayMonthYear
2 digit day, 2 digit month, 4 digit year
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