To:
The Dickensian, The Charles Dickens Museum, 48 Doughty Street,
London WC1N 2LX, England
From:
Name and address of the Institution (as it should appear on correspondence addressed
to you, including the
postcode)
Telephone:
....................... E-mail:
.................................................................................
|
| Please supply the three issues of The Dickensian published in 2008. |
| * Our remittance is enclosed. |
| * Credit card details are given below. |
| [* Please delete the statement which does not apply.] |
|
| Subscription: |
United Kingdom:
£25.00 p.a. |
Outside the UK: £28.00 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 |
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.
|