Last modified: 8th May, 2004
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Membership Application for The Shaw Society

I/we wish to become a Member/ Family Members of The Shaw Society, and enclose cheque / cash for £........ (to 31 December, but first four months free):

Name (Mr/Mrs/Ms) ...................................................................

Address(please print).................................................................................................

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

Postal Code........................................................... Tel No:...................................

Signed:..............................................Date:................................

I enclose membership fee (Please tick where applicable)
Individual Member£15.00
Two members at the same address£22.00..........
Overseas the same or$30.00
US or Canadian

Cheques and postal orders (sterling only, please)
(Special rates are quoted for payments other than in sterling (eg $US 30))
should be made payable to The Shaw Society
and forwarded with this form to the Treasurer.
1 Buckland Court
37 Belsize Park
 London NW3 4EB
E-mail: shawsociety@blueyonder.co.uk