Irish Society of East Anglia

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                    Membership Application Form

Name/s

 

Address

Telephone Number

 

  
Mobile Number

 

  
Email

 

  

 

Membership Fees ( To be renewed Annually ):

 

Members: (People of Irish Birth / Descent) Individual £10:00 / Family £15:00 / OAP £7:00
Associate Members: (Other Nationals) Individuals £10:00 / Family £15:00 / OAP £7:00

 

Are you of Irish Birth?       Yes/No
Are you of Irish Decent?       Yes/No
Place of Birth:  
Originating From:  
   

“I/We wish to apply for membership of the Irish Society of East anglia and undertake to abide by the society rules

 

 

Signature:

 

 Date:
Please make completed cheques payable to Irish Society of East Anglia. Send cheque and completed form to:

Elizabeth Dower, Treasurer, Newland Villas  34 Station Road, Reepham, Norwich, Norfolk, NR10 4LN

 

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