a Membership Application Form

Lay Members’ Day 2013
Subscriptions are payable by cheque, credit card or standing order. Cheques in pounds sterling are acceptable drawn on any UK bank.
US personal cheques may be made payable in US dollars. All cheques should be made payable to ‘Society of Scribes & Illuminators’.
Credit card payments should be in pounds sterling and are subject to a handling charge of 10%. Subscriptions are renewable annually.
A reminder will be sent with the mailing before the renewal date. Subscription rates below are valid as of November 2010.
Surname . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Title . . . . . . . . . . . . . . . . . . . . .
Forenames . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Postcode/Zip Code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Country . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Telephone No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
E-mail address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Occupation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Special Interests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Are you a teacher of calligraphy? Yes
No
PLEASE TICK THE APPROPRIATE RESPONSES
I would like to join as Lay Member (UK £32, EU £34, Other £36 or $US67)
Yes
No
I claim a UK student rate of £18
Friend (UK £26, EU £28, Other £33 or $US61)
(If claiming, enclose a photocopy of student card and course name)
Yes
No
I claim a deduction of £15/ US $29 for Additional Membership
as I reside at the same address as
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (not available to students)
Amount of cheque in pounds sterling (drawn of any UK bank) . . . . . . . . . . . . . or US dollars . . . . . . . . . . . . . payable to ‘Society of
Scribes & Illuminators’. Or if paying by credit card: Mastercard
Visa
Amount to be charged (in pounds sterling only. Please add handling charge of 10%) . . . . . . . . . . . . .
Card No:
Expiry Date. . . . . . . ./. . . . . . . . / . . . . . . . . . . . . . . . . . . . .
Please send your 3-digit security code (CSC code, the last three digits on the back of the card) under separate cover.
Name on card . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Date. . . . . . ./. . . . . . ./. . . . . . . . . .
In future I would like to pay
send me
theme
relevant
information
pay by
by Standing
Standing Order
Order (UK
(UKMembers
Membersonly).
only) Please Please
send
the relevant
information (tick box).
As a member of the SSI, your
your name
name will
will be
be kept
kept on
onaacomputer
computerdatabase
databasefor
foradministrative
administrativepurposes.
purposes.From
Fromtime
timetototime
timethe
theSociety
Society
publishes a list of names
numbers)
of itsofmembers.
You You
havehave
the right
to request
that your
namename
names and
and addresses
addresses (excluding
(excludingphone
telephone
numbers)
its members.
the right
to request
that your
is not included in such aa list.
list. IfIf you
you do
do NOT
NOT want
wantyour
yourname
nameincluded
includedplease
pleasetick
tickhere
here
Please print this form and complete it, then send it with your subscription to:
SSI Membership Secretary, Nicky Tait, 19 Eleanor Crescent, London, NW7 1AH, UK
email: [email protected]