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:



Signature:




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,
REIGATE,
RH2 0SP.

Shortly afterwards you will receive a joining pack by post.