| 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 |