| To print this Form press CTRL P on your PC (Command P on the Mac) |
Please enrol me/us in the Society as:
(Please tick one box. NB Membership rates are as of Oct 2007. )
| Life Member (£750) | | Senior Member (£60)|
| Senior Life Member (£500) | Joint Senior Members (£100) | Single Member (£70) | Youth Member (£30) | Joint Members (£120) | Friend (£20) | |
| Title: | First name or initials: |
| Surname: | |
| Address: | |
| Postcode: | Tel: |
| Email: | |
| I heard about the Society from: | |
| Date: | I enclose a cheque for £ Payable to The Chopin Society |
| SIGNED: |
|
Please complete this form and send with your cheque, made payable to "The Chopin Society", to:
The Secretary
The Chopin Society
44 Bassett Road
London W10 6JL
We will then send you your Membership Card and the latest Newsletter.