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Type of membership (tick box)

[   ] Individual £8 .. [   ] Double £14 .. [   ] Student

Type of payment

[   ] Cheque .. [   ] Banker's order

Name (Mr/Mrs/Miss/Ms/other): 

Address:



Telephone:


Please return this form with your payment, cheques payable to Richmond Local History Society, to:

The Membership Secretary
10 Courtlands Avenue
Hampton
Middlesex TW12 3NT

N. B. If you would prefer to pay your subscription by Standing Order please contact the Membership Secretary for further details, or email the Society at rich.hist@yahoo.co.uk.