M500 Society Membership Application Form
     
Title: Forename: Surname:
     

Address:

 

 

PostCode:
Telephone Evening:  
  Daytime:  
E-mail address:    
     
OU Identifier:    
     
OU Region:    
     
Do you wish your details to be included in the listings?: MOUTHS: Yes / No
    MATES: Yes / No
(Note: Applicants to join MATES are liable to be screened by the Civil Authorities)
     
Courses on which you can offer help for MOUTHS or MATES:
     
Previous:    
     
Current:    
     

Print out this form, complete it and post, with a cheque drawn against a UK bank account.
made payable to 'M500 Society', to:
Mr Jeremy Humphries, M500 Society, 36 Penmanor, Finstall, Bromsgrove B60 3BZ

UK-based subscription fee £15.00
For an address in Continental Europe please add £5 for handling and postage fees
For all other addresses please contact Jeremy (email: jeremy@m500.org.uk)

The M500 Society is registered under the Data Protection Act (1998).

Office Use:

Ledger Number:

Date Processed:
[Membership]

[September Weekend]

[Winter Weekend]