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The Dickensian - Order Form for Individual Subscribers 2007

To:
The Dickensian, The Charles Dickens Museum, 48 Doughty Street, London WC1N 2LX, England

From:
Your name and address (as they should appear on correspondence addressed to you, including the postcode)

 

Telephone: ................................... E-mail: ...........................................................................

Please supply the three issues of The Dickensian published in 2007.
* My remittance is enclosed.
* Credit card details are given below.
[* Please delete the statement which does not apply.]
Subscription: United Kingdom: £16.00 p.a. Outside the UK: £17.50 p.a.

PAYMENT BY CREDIT OR BANK CARD

Please debit our card to the value of £ __________________________

Type of card (please circle one of the following - no other cards are currently acceptable):

 Visa / Mastercard / Amex / Visa Electron  Delta / Switch / Solo  JCB
 Card Number:
                               

Issue No. or start date (Switch & Delta): ……………. Expiry date (all cards): ……………

Security code: ............... (last three digits of the number on the signature strip)

Name of cardholder, as printed on the card (in block capitals): ...................................................

Signature of the cardholder: ............................................. Date: .........................................

Information provided by subscribers is used solely for Fellowship business. Although every effort is made to respond promptly to enquiries and applications, delays are sometimes unavoidable - we have no paid staff to handle correspondence.