Membership Registration Form

Please make sure you respond to all sections marked with a red asterisk *

NEW MEMBER REGISTRATION - Please tick the required membership option(s). Junior membership can be held on its own or with individual or joint membership *

£15 Individual Membership
£20 Joint Membership
£5 Junior Membership

If you are registering for joint or junior membership, please note that the Society keeps in direct email contact with just one member of the household. Please enter the nominated person's details below.

Title (Mr, Ms, Dr etc) *

Full Name *

Email *

Please enter a telephone number so we have an extra way of reaching you if email fails. The number of a mobile (cellphone) would be preferable. *

For joint memberships give the name of the second person

Add an email address for the joint member (optional)

Please list any junior members here and add their email addresses if desired

What is the total amount you will be paying? *

Individual membership £15; joint membership £20; junior membership £5

Address 1 *

Address 2 *

Address 3

Address 4

Postcode or Zip *

Country *

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

How did you hear about the Society?

Gift Aid - UK Taxpayers only - I wish to Gift Aid all donations made in 2022 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. *

Yes, I agree
No
Not a UK taxpayer

How do you intend to pay your subscription? *

Name