Print the form HURSTPIERPOINT SOCIETY Registered Charity 263520. MEMBERSHIP APPLICATION FORM We keep our subscriptions as low as possible, £2 for an individual, £3 for a couple. Life Membership is also available at £20 single or £30 couple. If you wish to join the Hurstpierpoint Society and make your voice heard, please complete and return this form together with your subscription. NAME: .............................................................................. ADDRESS: ........................................................................ ......................................................................................... POSTCODE: ..................................... PHONE: ........................................... EMAIL ................................................... If you are a UK taxpayer you can make your donation worth about a quarter more at no extra cost. Please sign below if you pay tax and are willing for the Society to claim Gift Aid. SIGNED: ................................................... DATED: ................................................ Please send to the; Membership Secretary: 20 Hassocks Road Hurstpierpoint, West Sussex, BN6 9QW or c/o The Mint House, 94 High Street.