Application Form

Membership Application Form

Title:

________________________ (Mr. Mrs, Miss,  Other)

Name:

______________________________________________________

Address:

______________________________________________________
______________________________________________________
______________________________________________________

Post/Zip Code:

______________________________________________________

Telephone Number:

______________________________________________________

Email address:

______________________________________________________

Please find enclosed to subscription of * individual (£25): institutional (£35) for membership of the Lancashire Parish Register Society.

* Please delete where appropriate and send your subscription to:-

Treasurer and Membership Secretary,
Mrs Jackie Roberts,
Lancashire Parish Register Society,
13 Corrie Drive,
Kearsley,
Bolton,
BL4 8RG

Payment must be made by cheque, drawn on a British bank, and made
payable to LPRS.

Subscriptions are due on January 1st of each year. Standing Order forms are available from the Treasurer.

Please note that new publications will be sent to the above address during the course of the year by second class or surface mail so DO ensure the
details are complete AND advise us of any changes!