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Elgar Society Membership Postal Renewal
Form
Please print this form and, having completed it, return it to :
Jon Goldswain, 6 Charlock Road,
Barnards Green, Great Malvern, Worcestershire, WR14 3SR
Name :
...............................................................................................................
Membership Number : ........................................................................................
Address : ............................................................................................................
...........................................................................................................................
Postcode : ............................ Telephone Number : .............................................
e-mail address : .................................................................................................. |
I enclose payment of (tick as appropriate, see note 1).
For details of how to pay, see note (2) :
Full Member :
2 Full Members at same address :
Student Member :
2 Student Members at same address :
1 FM and 1 SM at same address: |
(UK & Europe)
..... £30.00
..... £35.00
..... £15.00
..... £17.50
..... £20.00 |
(Worldwide)
..... £32.00
..... £37.00
..... £16.00
..... £18.50
..... £21.00 |
I wish to pay by Visa / Mastercard (delete as appropriate)
Card number : ....................................................................................................
Card security number : ........................................................................................
Expiry date : ....................... Name on card : ......................................................
Address associated with card (if different from above) : .......................................
...........................................................................................................................
Postcode : .......................................................................................................... |
| Signature :
.......................................................................................................... |
| Date :
................................................................................................................. |
Notes :
(1) - As Student Members pay a reduced fee, and as the mix of Full and Student Members at the same address can
vary, care should be taken in selecting the correct category for payment.
(2) - Payment may be made by credit card (Visa or Mastercard) or by cheque made out in pounds sterling. Because of
the high bank charges on International Money Orders, the Society cannot accept payment in other currencies.
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