I/we would like to join Hampshire Industrial Archaeology Society.

Full name:   .......................................................

Address:     ......................................................

......................................................

.......................................................

Post code:   ....................  Telephone: ......................

Membership type:    [ ORDINARY / JOINT / OUT-OF-COUNTY / CORPORATE ]

Note:  The above details, together with subscription payment records, will be stored on a computer.   They will not be disclosed to anyone outside the HIAS committee without your permission.   If you make a Gift Aid Declaration, it may be disclosed to the Inland Revenue.

An address list is issued to all members from time to time.

Do you wish to be included?  [ YES / NO ]

I/we enclose a subscription of £__________ (please make cheques payable to "HIAS")

[ Ordinary £11 / Joint £16.50 / Out-of-county £8.50 / Corporate £18 ]

Signature:  .............................................................

Date:       ....................

  GIFT AID

I would like Hampshire Industrial Archaeology Society (registered charity number 276898) to reclaim the tax on any donation or subscription payment I make on the date below or make hereafter, until I notify you otherwise.  I pay UK income tax or capital gains tax each year at least equal to the tax that will be reclaimed;  I will notify you if I cease to do so.

Signature:  .............................................................

Date:       ....................