BROCKWELL FAMILY HISTORY SOCIETY
APPLICATION FOR MEMBERSHIP

Date:

Name……………………………………...…………………………….….
Address……………………………………………...………………………
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……………………………………………………...…………………..
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Telephone……………………..Email…………………………….…...
wish to become a member of the Brockwell Family History Society.

I agree that my details may be held on computer by the BFHS *
I agree that my details may be published in the "Brockwell Review" *
* Please delete as necessary if you do not agree.

The annual membership fee is £5.00 UK, £7.00 overseas.
Membership runs from 1st January for 12 months.

I enclose a cheque for:

Membership fee	£
Donation	£
Total	£

Please make cheques (in Pounds Sterling please) payable to Brockwell F.H.S.
and send to :-

Mrs Anne Simmonds
BFHS Membership Secretary
6 Marlborough Road
BEDFORD
MK40 4LG
U.K.