AGES
Archaeological & Historical Association

APPLICATION FOR MEMBERSHIP

MEMBER DETAILS
Name:
Address:
Telephone No:
Mobile No:
Email address:
MEMBERSHIP TYPE (Tick box)
Individual Membership:
£ 15.00
Household Membership:
£ 20.00
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
Name: Age if under 16

Children under 16 must have parent/guardian onsent 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