| Membership Application / Renewal |
Please print IN BLOCK CAPITALS and return with payment, to:
 David Burgess, 10 St Andrews Drive, Alwoodley, LEEDS, LS17 7TR |
Membership number (if renewing): |
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Style: Mr / Mrs / Miss / Ms / Mr & Mrs / Other (please state): |
Surname: |
Forename(s): |
Full Postal Address: |
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Postcode: Telephone No: |
e-mail address: |
Type of membership (Details) |
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I would like a copy of an electronic journal sent to my e-mail address [ ] tick |
Which Branch(es) (if any) might you attend? |
Which Branch areas cover your research interests? |
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I enclose a cheque (sterling only please, payable to LFHHS) for £ |
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I will pay by VISA or MASTERCARD only (please say which) |
Total Value of Payment: £ In Words: |
My card number is: |
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Name on card (BLOCK CAPITALS PLEASE): Expiry Date
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Signed: Date: |