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Irish Society of East Anglia |
| Membership Application Form |
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Address |
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| Telephone Number | |
| Mobile Number | |
| 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: |
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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 |