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 email@example.com).
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