Derbyshire Archaeological Society

Membership Application

Society Rules are such that membership forms must be signed by the applicant. Please fill in your details below, print out, and send to the address at the foot of the form.


Forename
Surname
Address
Postcode
Telephone
email address

Student membership

Date of Birth:

School or College:

Additional Members of Household



Membership category

One or more persons of a household at the same address£18.00
Student membership for persons under 25 in full-time education£13.00
Derbyshire Miscellany, the local history publication£6.00

The annual subscription is due on 1 January

SignatureDate
SignatureDate
SignatureDate
SignatureDate

Please return the completed form to:
Membership Secretary, 107 Curzon Street,
Long Eaton, Derbyshire, NG10 4FH

Please make cheques payable to: Derbyshire Archaeological Society
Standing Order or Gift Aid forms are available on request.

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