THE LITTLE MIDLAND SOCIETY, CHESTERFIELD

MEMBERSHIP APPLICATION

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

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

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Postcode………………………………….                       

Date of birth if under 18………………………………………………………….

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

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

Please see current rates for the amount

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

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

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