Friends of Erasmus Darwin House
Application for Membership
I / We wish to become Ordinary / Concessionary / 10 Year / Life Member(s) of The
Friends of Erasmus Darwin House. (Delete as appropriate)
My / Our intended subscription is £ __________________
NAME ____________________________________________________________
(Mr/Mrs/Miss/Dr) (block caps)
ADDRESS _________________________________________________________
___________________________________________________________________
___________________________________________________________________
POSTCODE ______________________ TEL ______________________________
EMAIL _____________________________________________________________
Please make cheques payable to The Friends of Erasmus Darwin House and send to
the Hon, Treasurer at the address given on the below. Thank you.
Payments by Standing Order
You may wish to pay future Membership Subscriptions by Standing Order. This will
be welcomed by The Friends of Erasmus Darwin House
If you would like the Treasurer to send you a Standing Order form, please tick the
box below.
I would like to make future payments by Standing Order
The Treasurer regrets to inform you that The Friends of Erasmus Darwin House
cannot accept payment for subscriptions by Credit or Debit cards.
The Hon. Treasurer
Carol Hannam
52, Kensington Oval
Boathouse Field
Lichfield
Staffs
WS13 6NR