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New Members Application Form ..................................... Please complete this form together with the Standing Order Form and send it to Peter Lush,  Membership Secretary, 25 Maumbury Square, Dorchester DT1 1TY Telephone - 01305 260039     Email - peterlush3@hotmail.com Annual subscriptions for Members are due on 1st October each year and are collected by Standing Order only. New Life Members should send a cheque made payable to “The Society of Dorset Men” Please enrol me as: [ ] A Life Member £200 [ ] A Member £15 per annum (tick one)
Title Mr/Dr/Rev/Other……………….Surname…………………….…………………...Date………………… First Name(s)……………………………………………………………................................................................ Address..................................................................................................................................................................... ................................................................................................................................................................................... Post/Zip code.............................................  Telephone.......................................................................................... Email:...................................................................................................................................................................... I am associated with the Dorset Town or Parish of ………………………………………………………....... By Birth, Descent, Marriage, Property, Other ( Delete those that do not apply). Do you object to the Society holding your membership record on computer.......................YES/NO Introduced by......................................................................................................................................................... ………………………………………………………………………………………………………………………
Standing Order Form To................................................................................ Bank Plc ………….........................................................................Branch
Address............................................................................................................................Postcode........................... Sort Code......................................................   Account No..................................................................................... Account Name(s)...................................................................................................................................................... Please pay HSBC Plc, 18 St Mary Street, Weymouth, Dorset DT4 8PH Sort code 40-46-23 for the credit of the “Society of Dorset Men”  Account Number 21182226 the Sum of £15-00 (fifteen pounds)  commencing IMMEDIATELY and then annually from 1st October 20 until you receive further notice from me in writing and debit my/our account accordingly. Signed........................................................................................................................   Dated................................... Name (In BLOCK CAPITALS please).................................................................................................................. Please quote the reference........................................................................( for completion by Membership Sec.)