Lichfield Science and Engineering Society

Membership Application Form
Please print this form (use your browser's Print command), then send the completed and signed form along with your cheque to the Treasurer, Mrs Carol Hannam, 52 Kensington Oval, Boathouse Field, Lichfield, Staffordshire. WS13 6NR
Name: Dr/Mr/Mrs/Miss
Address:  
Postcode:   Tel.  

 

Subscription for full membership for 2008-2009 is £18 due 1st September. Reduced subscription after 1st January £9.00. Please make cheques payable to LSES. Full time students free.

 
Occupation:  
Interests:  
Signed:   Date:  

 

I agree to the above details being printed in the membership list issued only to members of the Lichfield Science & Engineering Society.
(Please delete if inapplicable)

I would be interested in receiving correspondence from the Society by e-mail

 

My e-mail address is .................................................................................................................................................