GwentFHS APPLICATION FOR MEMBERSHIP Form

CYMDEITHAS HANES TEULUOEDD GWENT
Registered Charity No.702333 (registered in England & Wales)
APPLICATION FOR MEMBERSHIP
For the year 1st Jan. to 31st Dec.200

Membership
Number

(for use by
the Society)

(insert last digit of year - please note that applications received after the end of October
are normally for memberships to start from 1st January of the following year)

[1] Title

Initials

Surname

Address

Postal Town

UK County/State

Post/Zip Code

Country

Phone No

(phone no. only required if you live in the UK)

E-Mail Address

Class of Membership Required/fee enclosed please tick relevant box(es):

Individual (£8)

# Family (£10)

Corporate (£8)

* All Overseas (£10)

* If Overseas, fee must be in £s (sterling): £10 paid via GENfair?

or International M.O., cash or cheque on British Bank (enclosed)?

# If Family Membership, details of the other person(s) (all must share the same address):-

[2] Title

Initials

Surname

E-Mail Address
if different from [1]

[3] Title

Initials

Surname

E-Mail Address
if different from [1]

Branch Membership
Members living in or near Gwent are invited to become a member of one of the Society's 6 branches

Do you wish to be? NO

or YES

If YES, please tick the box of the branch you nominate:

Abergavenny/Monmouth

Blackwood

Chepstow

Ebbw Vale

Newport

Pontypool

NOTE: You are welcome at the meetings of any branch, whether or not you have chosen to be a member of that branch;
but branch members will normally collect their copy of the Journal at a monthly meeting of the branch they nominated.

I wish to apply for membership of Gwent Family History Society and understand that, if accepted,
under the terms of the Society's Constitution the above details will be stored on computer,
but will be used only for administration purposes and in the pursuit of the objectives
of the Society, namely to promote and encourage the study of Family History.

Signed

Date

Please return this completed form to Membership Secretary, Gwent FHS,
5 Brookside, Ribble Walk, Bettws, Newport, Gwent, NP20 7EG

This section is for use by the Society's Officers

Received by

Amount

Date Received

Date Processed