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AGES
Archaeological & Historical Association

MEMBER DETAILS
Name:
Address:
Telephone:
Mobile:
Email:
MEMBERSHIP TYPE (tick box)
Individual Membership: £ 17.00
Household Membership: £ 25.00 Covers all living at above address.

If applying for Household Membership, please supply the information below for other household members.

Name: Age if under 16
Name: Age if under 16
Name: Age if under 16
Name: Age if under 16

Children under 16 must have parent/guardian consent and can join under a Household Membership only.

Please send the completed form, together with a cheque made payable to AGES AHA, to:

Terry Barclay, 10 Poors Lane, Hadleigh, Benfleet, Essex, SS7 2LN

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