Fareham Society logo   Application Form

Please complete this form and print the page (or write the details on a separate
sheet of paper), then send it with your subscription to the address below.

1. Title   Initials   Surname

2. Title   Initials   Surname

Address   Postcode

Tel No


Choose membership type:

    Adult £ 4.00      Adult couple £ 5.00   

   Senior £ 3.00     Senior couple £ 4.00

I/we would like to pay by standing order in future

Please tell me/us how Gift Aid can make this subscription go further.


Attached is cash/cheque payable to The Fareham Society, being my/our subscription for membership in the category shown.

I/We agree with The Society's aims.




Signed .........................................................


Send to:

  The Fareham Society   12 High Street   FAREHAM   PO16 7BL