Printable Application Form

Printable Application Form

If you wish to join the Society, please print this sheet and fill out the application form below. Send it together with your cheque for the appropriate sum to the membership secretary:

Mr J C Lacy
3 Norton Hall Cottages,
Norton Mandeville,
High Ongar,
Essex CM5 9RT

Please make your cheque payable to the Essex Rock & Mineral Society.

Note: Details entered on the form may be held on computer files and included in a membership list distributed to members of the Society.

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APPLICATION FORM (please use block capitals and return to the Membership Secretary)

Title: (Dr, Mr, Mrs, Miss, Ms) ................

Name:......................................................................

Address: ..................................................................

..................................................................

Postcode: ................................................................

Telephone: ...............................................................

How did you find out about the Society?

................................................................................
I am interested in: (please tick)
Fossils o Minerals o Lapidary o General o

SUBSCRIPTIONS
(please tick appropriate box)

Individual £10 per annum
over 18 years of age.

Family £15 per annum

(children are welcome to attend
Society activities provided they are accompanied by a member).

Membership is for 12 months and
expires on December 31st.
Applicants joining after July 1st
pay half of the membership
subscription for that year.