PLEASE PRINT THIS PAGE, COMPLETE AND POST WITH PAYMENT AS DETAILED BELOW

 

THE SHACKLETON ASSOCIATION

Membership Application Form

 

The information you supply is for the association records and is accessible (without contact details) only to fellow members on circulation of the membership list.

 

 

Surname           …………………………………………………….. Mr. Mrs. Ms.

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

                        ……………………………………………………..

                        ……………………………………………………..

Post Code        ……………………………………………………..

Country            ……………………………………………………..

Telephone        ……………………………………………………..

Email                ……………………………………………………..

Service Occupation …………………………………………………

Sqns/Stns         ……………………………………………………..

Years from/to   ……………………………………………………..

Christian Names ……………………………………………………

Nickname         ……………………………………………………..

 

 

Annual Membership Fees (Membership Year starts 1st February)

 

UK Member                            £12.50

Joint Membership                     £14.00

Overseas Membership              £15.00

Part Year (Sept. onward)         Half Price

 

When completed this form should be sent together with your subscription to:

 

Membership Secretary

The Shackleton Association

1 Deepdale

Wilnecote

Tamworth

B77 4PD

 

Queries? Tel: 01827 892 332