Membership Application

I would like to join the Cumbria Industrial History Society

I understand that, unless I give permission, my name and address will be held on a computer solely for the purpose of printing address labels.

Name ..........................................................................................................................................................................................................

Address ......................................................................................................................................................................................................

.....................................................................................................................................................................................................................

Postcode .................................................................

I can also be contacted by           

Phone Number (optional) ..........................................................................................

E-mail Address (optional) .........................................................................................

Signed ......................................................................    Date .....................................

Special Interest (optional) .......................................................................................................................................................................

Annual Subscriptions:       Single £7.50       Joint £10.00 (more than one person at the same address) 
Cheques payable to CIHS. Subscriptions are due for renewal on 1st January.

I wish to have this and any other payment made by me to be treated as Gift Aid. I am a UK taxpayer. Please tick here [   ]

Please return to:   Roger Baker, CIHS Membership Secretary, 3 Sun Street, Ulverston, Cumbria, LA12 7BX.
Or contact mbarb@freenetname.co.uk for more information. We look forward to hearing from you.