WHITWORTH HISTORICAL SOCIETY


Membership Application / Renewal form

I/we wish to become member/s of the Whitworth Historical Society
I/we wish to renew my/our membership 

Single membership:  £10
Double membership:  £20


Title(s):  __________

Name(s):   _________________________________

Address:   __________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

Post Code/Zip:  ___________________

Country (if outside UK): ______________________

Telephone Number:        __________________________

e-mail address:          _____________________________________


In compliance with the Data Protection Act all membership details will
only be held for society use, and will not be shared with any other 
3rd parties or organisations without the member’s permission.

Payments from overseas members should either be made by PayPal or by 
Direct Bank Transfer only, please contact the Membership Secretary at 
the address given below if you wish to use these methods. 

Total payment enclosed £_______________




Please send this completed form with your payment (cheque/Postal Order 
etc. made payable to: ‘Whitworth Historical Society’) to:-

Whitworth Historical Society, 
North Street, 
Whitworth, 
Lancashire OL12 8RE. 


For any further enquiries please contact the Membership Secretary at the address below:

memberships@whitworthhistoricalsociety.org.uk