Costume Society Membership Form

Please fill in the form and print off the results.
Return the completed form to:
Pat Poppy The Costume Society Membership Secretary
56 Wareham Road
Lytchett Matravers
POOLE
Dorset
BH16 6DS

Email:

Title: Mr/Mrs/Ms..

First Name:

First Name Required

Surname:

Surame Required

Address Line 1:

Address Required

Address Line 2:

Town

County or State:

Postcode:

Post/zip code Required

Country:

Required Field

Telephone:

Mobile:

Gift Aid: I am a UK tax payer and would like The Costume Society to reclaim the tax on any qualifying donations or subscriptions that I make. I confirm that I have paid an amount of UK income or capital gains tax equal to any tax reclaimed. Please Tick to agree.

Membership fees:
Please select the type of membership you require.
Applying for Student Membership, Please Insert your:

If you live outside the EC and would like your Journals and Newsletters to be sent air mail, pick the air mail option below.
Please Check a box

UK Individual £24.00	Overseas Individual £26.00	Individual Air £29.50
UK Student £12.00	Overseas Student £14.00	Student Air £17.50

You have selected:

Indicate your interests in costume by ticking the appropriate boxes below.

Status: Which Catagories and Era's interest you

Academic

Curator

Enthusiast

Collector

Other

Menswear	Womenswear	Childrenswear	Construction
Pre C14th	C14th	C15th	C16th
C17th	C18th	C19th	C20th
C21st

Please state whether you agree to your name being published in a membership directory:

Agree

Disagree

Please Agree or Disagree Please update before printing the results.

Please use the print button and Return this completed form to:
Pat Poppy
The Costume Society Membership Secretary
56: Wareham Road
Lytchett Matravers
POOLE
Dorset
BH16 6DS

£

Other

Course Title
Institution
Membership Directory: