Membership Application Form

Please print this form and fill it in (BLOCK letters only please).

I/We apply for Individual / Family / Corporate (delete as applicable) membership of the Reigate Society.

Name(s) - with Mr Mrs Miss Ms etc - or Company Name:

Address (with postcode please):

Email address:

Telephone number(s):

Please complete one of these two statements and delete the other:

I enclose a cheque for £............. made payable to The Reigate Society

I have sent a completed Bankers Order Form for £............. directly to my bank.

If applicable, date of annual payment on Bankers Order Form:

Name of person filling in form - in block letters please:

Date of filling in form:


Please send the completed form (with cheque if applicable) to the Hon Registrar of the Reigate Society at the address provided below:

Mr Robert Bogin,
Townsend House,
64 Church St,
RH2 0SP.

Shortly afterwards you will receive a joining pack by post.