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:
......................................................................
|
I/we wish to renew my/our membership of the Dickens Fellowship in 2008 and will pay the subscription(s) as indicated below.
|
| Membership
subscription |
£14.50
[+ £9.50 for each additional member at the same address]
|
£
.............. |
Subscription to
The Dickensian
at the reduced rate for members |
£12.00 |
£
............... |
Total
remittance enclosed / to be charged to my credit/bank card
(Cheques to be made out to 'The Dickens
Fellowship') |
|
£
............... |
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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