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APPLICATION FOR Corporate MEMBERSHIP YEAR 200 Name of Society or Organisation .................................................................................................................................... Name and address to whom correspondence should be sent. Name .................................................................................................... Address .................................................................................................... .................................................................................................... .................................................................................................... .................................................................................................... Post Code ................................. Telephone ................................. Email address .................................................................................................. Name and address of representative at meetings if different from above. Name .................................................................................................... Address .................................................................................................... .................................................................................................... .................................................................................................... .................................................................................................... Post Code ................................. Telephone ................................. Email address .................................................................................................. Do you object to the Association holding your membership record on computer? Yes or No Signed .................................................................................................... Date .................................................................................................... Please print and complete the above form, enclose a cheque for £20 payable to Cheshire Local History Association and send to: - Cheshire Local History Association Cheshire Record Office Duke Street Chester CH1 1RL (Please enclose SAE if receipt required) |