Printable Application for Membership

Information given below will be held on computer to ease our mailing list administration.
It will not be passed to third parties or be used for commercial purposes.

Title: Select Mr Mrs Ms Miss Dr Prof Rev Other	First name:	Last name:	Date of Birth:
Membership may be for two people at the same address. Please give details of second person below.
Title: Select Mr Mrs Ms Miss Dr Prof Rev Other	First name:	Last name:	Date of Birth:

Postal address (including postcode):


Telephone:


E-mail address:


Are you agreeable to having your name and address published
in future editions of Peewit, the Society Members Directory?
Yes No
If the answer to the above is yes, do you wish your telephone
number to be included?
Yes No
Again, if the answer to the above is yes, do you wish to add any
descriptive comments to your Peewit entry?
Note: if the scroll bar appears, your printer will only show the visible part of the text.
If you really need more space, write it manually on the bottom, or on the back of the sheet!

How did you hear about the Malcolm Saville Society?:
Internet Facebook Recommendation Advert in book Bookshop Newspaper article Magazine article Radio programme Pamphlet Other

Membership is renewable each June 1st. Membership applied for now will last until 31st May 2012.

UK membership: £10.00 per annum, European membership £12.50 per annum,
Rest of the world membership £16.00 per annum (Sterling only please).
Payments should be made payable to 'The Malcolm Saville Society'
After printing this form, please post it with your payment to
The Malcolm Saville Society, Woodside Cottage, 11 Stanford Road, Great Witley, Worcestershire, WR6 6JG