Corsham Civic Society Membership Application NameStreet AddressCityCountyPostal CodeEmail AddressPhoneMembershipI wish to become/renew my membership of the Corsham Civic SocietyCheckboxFull Membership £15.00 (annually)Full Membership x 2 (same household) £12 each (annually)Full Membership 5 Years £60Payment OptionBACSChequePlease select a payment optionBACSPayment can be made via BACS to: Account Name: CORSHAM CIVIC SOCIETY Sort code: 30 91 99 A/C Number: 01265754ChequesPlease make cheques payable to 'Corsham Civic Society' and send to the Membership Secretary: Michael Rumsey91, Tellcroft CloseCorshamWiltshireSN13 9JQApply for Membership
