Membership Form

SMETHWICK LOCAL HISTORY SOCIETY MEMBERSHIP FORM

I/we would like to join Smethwick Local History Society (please delete as necessary)

Name(s) .........................................................................................................................…………

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Address: .........................................................................................................................………..

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Telephone Number: ......................................................................................................

I enclose cheque/Postal Order for £ ............................................................................

(please make cheques payable to "Smethwick Local History Society")

Please Note:

The Society holds its mailing list on computer. In order to comply with the Data Protection Act, we need your permission to store your name and address on an electronic system. The Committee of this Society guarantees that the list will contain only your name and address, and will be used for the sole purpose of sending information to you about Society activities. Your name and address will not be sold or passed on to any other organisation. As a formality, please complete the form below to grant the required permission:

I hereby give permission to Smethwick Local History Society to hold my name and address on an electronic mailing list:

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

Block Capitals ..........................................................................................