Christmas Voucher Application

Christmas Voucher/Membership Application

Northamptonshire Family History Society
Is this voucher to be used on your behalf or as a gift for someone else?*

for me (purchaser)for someone else (recipient)
Do you wish...*

to forward the voucher to the recipient yourself? - (the voucher & an application form will be sent to you.)us to forward the voucher to the recipient? - (the voucher will be sent directly to the intended recipient.)
I/We apply for membership of Northamptonshire Family History Society
Purchaser Name*

TitleFirst NameLast Name
Purchaser Email*
example@example.com
Purchaser Home Phone
Please enter a valid phone number.
What do you like to be known as?
Purchaser Mobile Phone
Please enter a valid phone number.
(Address - where you will be paying via Parish Chest, there is no need to fill in your address details on this form as we can take them from the Parish Chest order.)
Purchaser Address

Street Address

Street Address Line 2

CityCounty/State

Post / Zip Code
How did you hear about the Society?
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
Recipient Name*

TitleFirst NameLast Name
Recipient Home Phone
Please enter a valid phone number.
Recipient Mobile Phone
Please enter a valid phone number.
Recipient Address*

Street Address

Street Address Line 2

CityCounty/State

Post / Zip Code
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
Press Submit to register this application and to redirect you to the Parish Chest website page for Northants FHS - on the left menu, click Society Subscriptions, choose 'Northants FHS Membership - Christmas Offer' and pay by card.
Should be Empty:

Christmas Voucher/Membership Application

Consent to send PID outside the EU

Member's Name Interests