Membership Application Form

Please print out and complete the form below and return to: Jeremy Johns, Secretary, Polperro Family History Society, The Crown House, Clifton-upon-Teme, Worcestershire, WR6 6EN, UK.

Mr/Mrs/Miss/Ms………………………………………………………………………

FULL NAME:……………………………………………………………...................

ADDRESS:………………………………………………………………...................

…………………………………………………………………………….................

POSTCODE:………………........…TELEPHONE:……………………………........

E-MAIL ADDRESS:…………………………………………................……………

INTEREST:……………………………………………………………….................

Your research interest will be listed in the Members' Directory. Do you wish your e-mail address to be included as well? YES / NO

Subscriptions cover the calendar year from January to December for the year in which you are joining.

Class of Membership - please circle

Please make cheques payable to Polperro Family Historians

For further details e-mail: jeremy.johns@polperro.org