Bluebell Railway Preservation Society - Membership Application Form
Please do not use this form for renewals.
I/we wish to apply to become a Member of THE BLUEBELL RAILWAY PRESERVATION SOCIETY,
being in broad agreement with its aims and principles and I/we agree to abide by its rules. 
Type of Membership required - TICK BOX
Adult                                      £ 17  [ ]
Joint (2 Adults)                           £ 25  [ ]
Senior Citizen (aged 60 years or over)     £ 10  [ ]
Joint Senior Citizens (both 60 or over)    £ 17  [ ]
Family (2 Adults + up to 3 children)       £ 28  [ ]
Juniors (under 16. Date of Birth:__/__/__) £ 10  [ ]
Full Time Student                          £ 10  [ ]
Life Membership                            £ 400 [ ]
Partner of existing Life Member            £ 200 [ ]
Donations welcome (especially from overseas members to help defray the extra cost of postage).

Cheques to be made payable to "B.R.P.S." please
Or, please debit my Mastercard/ Visa Account with £ . . . . . . 
No: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
Start date (if shown): .../...    Exp Date: .../...
Security Code (last 3 digits): .....
Please complete in BLOCK LETTERS.                       Date: ..............
Surname: .............................................  Title: .............
First Name: ................................................................
Address: ...................................................................
............................................................................
..............................................  Postcode: ..................
Telephone No: ..............................................................
Email address: .............................................................
       Do you wish to receive a news update via email?  Yes/No

Signature ............................................ 

For Joint/Family Members only
Spouse/Partner's Surname: ..................................................
First Name: ..........................................  Title: .............

For Family Members only - Name of children and Birth Date:
Child 1: ................  Child 2: ...............  Child 3: ..............
DOB:     ___/___/___                ___/___/___               ___/___/___
Data Protection:The information provided on this form by the applicant is for BRPS purposes and will NOT be passed on to any other organisation.
Under Rule 4 of the Society's rules, membership is dependent upon payment of the prevailing subscription, and is at the discretion of the Society Committee. Should the Committee decline an application, any subscription paid will be returned in full.
Send the completed form and payment to:
Membership Secretary (BRPS), Sheffield Park Station, Nr. Uckfield, East Sussex, TN22 3QL
 
Office use only: AMS [       ]   R/No [        ]   Mem/No  [        ]
               DB [          ]      Renew [01 /    /      ]
Internet Membership Form, May 2006