George Eliot Fellowship Membership Form

Last modified:5th June, 2002

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Membership Application for the George Eliot Fellowship

.	U.K.	U.S.A.
Annual	£ 10	$ 25
Pensioner	£ 8 (UK only)	-
Student	£ 8, age limit 25 (UK only)	-
Second member of household sharing annual member's literature	£ 1	$ 3
Life Membership	£ 100	$ 250
Pensioner Life Membership	£ 80	$ 200
Life Member's Spouse	£ 5	$ 10

*Full Name........................................................

Title: (Mr/Mrs/Miss/Ms).....................................

Address (including post or zip code)

....................................................................................................................

..........................................................................

Telephone............................

*Please include the name of spouse or second member of household.
Total sum enclosed Ł.........................
U.K. subscriptions and overseas subscriptions, other than U.S. subscriptions, which should be made in sterling, either by an international money order or by a cheque drawn on a London based bank, and made payable to The George Eliot Fellowship.

Please complete the application and send it to:

Mrs Kathleen Adams
71 Stepping Stones Road
Coventry, Warwickshire
CV5 8JT

or to:

Dr Linda K. Robertson
PO Box 10167
Springfield, MO 65808-0167

Signed..................................................
American subscriptions should be made payable to Dr. Linda K Robertson
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