
UK Membership Form/Renewal Form
. . . . . . . . New membership OR . . . . . . . . Renewal
2. Select membership category required:
. . . . . . . . £20 Individual membership
. . . . . . . . £25 Family membership
. . . . . . . . £40 Supporting membership (for yourself and an in-country national)
. . . . . . . . £40 Institution/Library subscription
3. Name and address for Sandgrouse mailing:
Name ______________________________________________________________________________________
Address ____________________________________________________________________________________
____________________________________________________________________________________________
_______________________________________________________ Postcode _________________________
Email address ___________________________________ (for administration only)
4. Payment - please select and
complete 4a or 4b:
4a . . . . . . I enclose a Cheque (made payable to OSME) for £ ___________
4b . . . . . . I would rather pay by debit/credit card the amount of £ ___________
VISA _______ MASTERCARD _______ (tick as appropriate). No other cards accepted
Card number _________/_________/________/________ Expiry date ________/________
Name
as on card __________________________________ * Security
No __________________
*
the three digit number above signature on back of card
Signature ____________________________________________ Date _______________________
OSME is a UK Registered Charity No. 282938