Please print the form, fill it in and post to:

Dean Jagger

LMS Membership Secretary

492 Sheffield Road

Whittington Moor

CHESTERFIELD

S41 8LP

THE LITTLE MIDLAND SOCIETY, CHESTERFIELD

MEMBERSHIP APPLICATION

Name(Please print)……………………………………………………………………………………

Address………………………………………………………………………………………………..

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Postcode………………………………….  

Email address…………………………………………………………………………………………..

Contact telephone………………………………………………………………………………………    

Age if under 16………………Please note members under the age of 16 MUST be accompanied at all times by a responsible adult.

I wish to join as a Junior (Under 16) / Adult (16-64) / Senior (65+) / Joint member.

Please delete as applicable.

I enclose a cheque payable to “The Little Midland Society” for £……………….

Please see website or notice board for current rates.

I have read  the Society’s rules and agree to abide by them.

Please tick the box to say that you agree.

Signed………………………………………………………….Date……………………………….

Your details are NEVER passed to anyone else.