Membership Application Form

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

First Name *
Last Name *
Email Address *
Telephone Number
House Number *
Address *
Postcode *

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) Individual £10.00 / Family £15.00 / OAP £7.00

Are you of Irish Birth ? Yes / No Place of Birth:

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

“I / We wish to apply for membership of the Irish Society of East Anglia and undertake to abide by the Society’s rules during membership”

Signature/s: _____________________Date: _

Please make completed cheques payable to Irish Society of East Anglia. Send cheque and application form to Elizabeth Dower, Hon. Treasurer, Newland Villas, 34 Station Rd., Reepham, Norfolk, NR10 4LN. Tel. 01603 870896

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For committee Attention Only:

Proposed by: ________________________ Seconded by: ________________________

Approved on: ________________Membership rules and letter sent on: _______________

*** www.irishsocietyofeastanglia.co.uk ***

Membership Application Form

Signature/s: ___________________________________Date: _______________

Signature/s: _____________________Date: _