To:
The Membership Secretary , The Dickens Fellowship, 48 Doughty Street,
London WC1N 2LX, England
From:
Your name(s) and address (as they should appear on correspondence addressed
to you, including the
postcode)
Telephone:
........................................ E-mail:
......................................................................
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We/I wish to become a member / members of the Dickens Fellowship in 2007 and will pay the subscription(s) as indicated below.
[Membership follows the calendar year, renewable in January. However, one may join at any time of the year, the annual subscription being reduced for new members from £14.50 to £8.00.] |
| New member
subscription |
£8.00 each |
£
.............. |
If you wish to subscribe to
The Dickensian
at the reduced rate for members, add |
£12.00 |
£
............... |
| To receive a geranium badge*,
add |
£1.00 |
£
............... |
Total
remittance enclosed / to be charged to my credit/bank card
(Cheques to be made out to 'The Dickens
Fellowship') |
|
£
............... |
* A red enamel lapel badge, representing the head of a geranium, the Fellowship's emblem
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 members 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.
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