I wish to join as a Member

Name ………………………………………….. Tel.no. ……………………………................

Address …………………………………………………………………………………...........

……………………………………………………………………………………………...............................................................

…………………………………………………… postcode …………………………...........................................

email address …………………………………………………………………………….........

I enclose payment for (please tick)

individual membership £10……………................. family membership £15……………......

Corporate/group membership £50…………......... donation to the museum……….............

I wish this payment to be used for Gift Aid. I am a UK taxpayer.

Signature of taxpayer ……………………………………………..…........................................

Date ……………………………………………..…........................................................................