| Ordinary Member (£10.00) | Please tick box as appropriate | ||
| Student Member (£5.00) | Please provide evidence of where you are studying | ||
| Joint Member (£12.50) | Sharing the same address and receiving one Journal | ||
| Institutional Member (£20.00) |
| Name |
| Address |
| Postcode |
| If you are not completing the bankers' order form below please make your cheque or postal order payable to Durham County Local History Society and enter the amount paid and the date in the boxes opposite. | Amount Paid £_______ |
Date ________ |
BANKER'S ORDER FORM
| To: | Bank PLC | Bank Sort Code |
| Branch | Account Number |
| Please pay now and on 1st April annually thereafter until further notice the sum of £…………. to the account of the Durham County Local History Society (account no. 80346519 at Barclay's Bank, University Branch, 26 New Elvet, Durham DH1 3AL). This order cancels and replaces all existing orders to the credit of the Society. |
| Signature | Date |
| Address | |
| Postcode |
| Please return to : | The Membership Secretary, DCLHS, 2a The Links, Cheveley Park, Belmont, Durham, DH1 2AG17 |