If you would like to become a Member of
THE BLACK COUNTRY SOCIETY
please print then complete and send to Membership Secretary Mr Tony Ridge
7 Wilton Close, Sedgley, Dudley. DY3 1HX


Category + Subscription Rates

a)

Individual

12.50 pa

b)

Groups (Societies/schools)

12.50 pa

c)

Individual + Spouse/Partner

15.00 pa

d)

Overseas - Worldwide

25.00 pa

Special first year offer 6.00 for a) and b), 8.50 for c) and 20.00 for d).


Payment must be by cheque or by Paypal by visiting: www.blackcountrysociety.co.uk/membership.

You must not use Banker's order for this offer.

 

Title:

Name/s:

Title:

Name/s:

or Group:

Address:

 

Postcode:

Email:

Telephone Numbers:

Method of payment:

1) By cheque enclosed herewith ........................

2) By Banker's Order Form: see below

Name of Bank:

Sort Code:

Address of Bank:

 

Post Code:

Account Number:

PLEASE PAY TO HSBC BANK, Wednesbury Branch, Sort Code 40-19-02 for the credit of

The Black Country Society Account No. 41083279 the sum of .......................... on

(date) ........................... and on that day each year until further notice quoting

Reference ..........................

Signed: ............................................................. Date: .....................................

Address:

 

Post Code: