Leicester Literary and Philosophical Society - Section 'C' Geology
Application for Membership
Name (Dr/Mr/Mrs/Ms/Miss)____________________________________________________________________
Address_________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Telephone_______________________________________________________________________________
e-mail__________________________________________________________________________________
I enclose payment - please tick as appropriate:
    Ordinary £7.00     Joint/same address £10.00     Parent Body member £5.00     Student £5.00

Subscriptions can also be paid annually by standing order. Please contact the Treasurer for further details.

Make cheques payable to Leicester Literary and Philosophical Society, Section C Geology.
Send your completed form and remittance to:

Mrs Eileen Johnson

Treasurer, Leicester Literary & Philosophical Society Section C,

Rosedean

Park Lane

Bagworth

Leicestershire LE67 1BB