Application Form to join The LEICA Fellowship

Please enrol me/us as a member/members of The LEICA Fellowship.
(please complete two forms for joint membership).

Individual subscription rates are:
Full year 16.00, due lst March
Half year 9.00, due lst September

Joint subscription rates are:
Full year 24.00, due lst March
Half year 14.00, due lst September


NOTE: You will be asked to send your subscription following verification of your application.


DATA PROTECTION ACT
I/we agree to my/our name(s) and address being kept in the Fellowship's computer
file for the purpose of creating address labels and a list of members only.

* Necessary Entries
Title: *
Forenames: *
Surname: *
House No./Name: *
Street: *
District:
Town: *
Post Code: *
Country: *
Telephone Number:
Email Address: *
Which Course did you attend?: *
Date of the Course: *
Comments to send: *