JCS Mem by RogerRowe2

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									                            THE JOHN CLARE SOCIETY

                                MEMBERSHIP FORM


Title (Mr/Mrs/Ms/Dr/Prof)


Full name


Address (please print
clearly)




Email address


Telephone

Skills (do you have any
experience/knowledge that
might be useful to the
Society – e.g.
conservationism, legal,
etc.?)

Where did you hear of        Via (a) the Web, (b) public library, (c) a friend, (d) a
the John Clare Society?      Society member, or (e) other means (please specify
(please circle the option    below)
which applies)

Membership rate (please tick the one which applies to you):

                                      UK rates:
Individual                        £ 12.00       Joint Individual              £ 15.00
Retired                           £ 10.00       Joint Retired                 £ 12.00
Group                             £ 15.00       Full time student              £ 5.00
Library                           £ 17.00
                                   Overseas rates:
All categories                    £ 17.00       USA $                         $ 34.00
                                                Euros                           22.00

Please complete and return with your cheque, sterling bankers draft or postal
order, made payable to THE JOHN CLARE SOCIETY, to the Membership
Secretary, Sue Holgate, 9 The Chase, Ely, Cambs, CB6 3DR, UK.

Members in North America may pay their subscriptions in US currency direct to the North
American branch: cheque made payable to the John Clare Society of North America and
sent to Prof James McKusick, Dean, The Davidson Honors College, University of Montana,
32 Campus Drive, Missoula, MT 59812, USA (email james.mckusick@unmontana.edu).

								
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