MEMBERSHIP REGISTRATION FORM
Choose the level of membership (*)



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Your Title (Mr, Miss, Dr etc) (*)

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Your Name (*)

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For joint memberships give the name of the second member

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Address 1 (*)

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Address 2 (*)

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Address 3

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Address 4

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Postcode or Zip (*)

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Country (*)

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Email address (*)

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Telephone (*)

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Our website contains a list of members, together with an idea of their general location (eg Herefordshire UK or Texas USA). Most entries also include an idea of the member's particular historical interests. To comply with UK data protection law, we need your permission before including your name.

May we include your name and general location? (*)

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Please tell us about any special interest you have in the Mortimers or medieval history

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How did you hear about the Society?

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Gift Aid - UK Taxpayers only
I wish to Gift Aid all donations made in 2017 and in the future to the Mortimer History Society (registered charity 1171392), I am a UK taxpayer and understand that if I pay less Income Tax or Capital Gains Tax than the amount of Gift Aid claimed on all my donations in that year, it is my responsibility to pay the difference. (*)



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How do you intend to pay your subscription?
It reduces our administration (and makes it simpler for you) if you set up a standing order. You can do this via Paypal if you have a Paypal account. If you would like to set up a standing order with your bank, choose that option and we'll send you a form to make it simple. (*)







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