Press "Print" on your browser, then click "Back"
The Northumbrian Language Society
Membership Application Form
| Surname
|
|
| Mr / Mrs / Miss / Ms / Dr / | Initials/ Forename |
| Address:
|
|
| Postcode | Tel No. |
| Please enclose your annual subscription of £5 (£2
OAP & Child. £6 Couple) and
post to: Miss H Dickson 95 Rosalind Street Ashington Northumberland NE63 9BW
|
Please indicte your area(s) of interest Talks
|
| DATA PROTECTION ACT: I agree to these details being held on computer by and solely for the use of the Northumbrian Language Society | |
| Signature:
|
Date:
|