The Ormskirk & District Family History Society

PO Box 213, Aughton, Ormskirk, Lancashire L39 5WT

website: www.odfhs.org.uk email: secretary[at]odfhs.org.uk

Membership Application Form

Mr/Mrs/Miss/Ms/Other . . . . . . . First name(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Surname . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

PostCode . . . . . . . . . . . . . . . . . . . . . .Tel No. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

E Mail address . . . . . . . . . . . . . . . . . . . . . . Family tree Web site . . . . . . . . . . . . . . . . . . . . . . . . .

I/We wish to join the Ormskirk & District Family History Society in the class of:

Date of joining	(Please tick one box only)
1 Apr - 30 Sep:	Individual (£11) [ ] Family (£13) [ ] Corporate (£15) [ ] Overseas (£15) [ ]
1 Oct - 31 Mar:	Individual (£6) [ ] Family (£7) [ ] Corporate (£8) [ ] Overseas (£8) [ ]

Annual renewal date is the following 1 April at the renewal rate (see Subscription Rate table)

I/We enclose a cheque/P.O. for £ ................. payable to Ormskirk & District FHS

Signature(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Brief details of Surnames being researched (Please limit to 4).
Would you like these to be included on our website Members Interests page? y / n;
Also on our Society Magazine? y / n;

May we:
list your email address? y / n; list your name? y / n; address? (Magazine only) y / n;
list your telephone number? (Magazine only) y / n;

SURNAME	LOCATION & COUNTY	DATES