Historical Diving Society - Membership Form
PLEASE COMPLETE IN BLOCK CAPITALS

First name:

Last name:

Address:

 

Post code/Zipcode:

Country:

Telephone number:

Fax number:

Email address:

Website URL:

Type of Membership:

If applying for Corporate membership, state name of organisation and its main activity:

Please tell us a little about your interest in Historical Diving:

 

I wish to become a member of the Historical Diving Society. I enclose the appropriate fee and agree to abide by its Rules and Constitution.

Signed:

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

Date:

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

For
Office
Use


METHOD OF PAYMENT please tick

CHEQUE
 
POSTAL ORDER
 
ACCESS
 
MASTERCARD
 
VISA
 
 
CARD NUMBER
                               
SECURITY CODE
last 3 digits of code on signature strip
     
EXPIRY DATE
       

NAME OF CARD HOLDER:

PLEASE POST COMPLETED FORM TO: The Membership Secretary, 55 Carillon Court, Oxford Road, Ealing, London, W5 3SX, United Kingdom