GENUKI Home page up Devonshire Association ContentsContents & Search
 
 

APPLICATION FORM

(Please print, and send the completed form to the Association)

I wish to become a Member / Second Member at the same address / 
Life Member / Student Member / Institutional Member / 
Associate of the Devonshire Association. 

If elected 1 agree to abide by the Rules of the Association.


Signature: .........................................................
	

SURNAME: ...........................................................

TITLE Mr / Mrs / Miss / Ms: .............

FORENAMES: .........................................................


ADDRESS: ...........................................................

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

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


Postcode: ..............................

Telephone Number: ......................

Letters after name: ....................

Occupation (now / before retirement): ..............................


I wish to join  ................... Branch 

I wish to join the following Sections: Please tick appropriate box(es)

Botany [ ]	Buildings [ ]	Entomology [ ]	

Folklore [ ]	Geology [ ]	History [ ]

Literature [ ]	


INSTITUTIONAL MEMBERS ONLY: 

Contact name or position: ...........................................

Address for invoices: ...............................................

Brian Randell, last updated 8 Dec 2001

Return to top of page

Note: The information provided by GENUKI must not be used for commercial purposes, and all specific restrictions concerning usage, copyright notices, etc., that are to be found on individual information pages within GENUKI must be strictly adhered to. Violation of these rules could gravely harm the cooperation that GENUKI is obtaining from many information providers, and hence threaten its whole future.