BURSLEDON BRICKWORKS

 Bursledon Brickworks

INDUSTRIAL MUSEUM

Application Form
Friends of Bursledon Brickworks

If you would like to join the "Friends of Bursledon Brickworks", and/or become a volunteer helper, please complete this form.

Please fill in your details on screen, print the form, then sign it, attach an appropriate cheque and despatch by post.
Title
Familial Name
Surname
Address
Address
Address town
County (Other County)
Post Code
Telephone Number
e-mail address (if available)
I would like to become a "Friend"
I would like to become a Volunteer helper
I would like to become a member
Annual Family membership is £15; individual membership is £10

Signature _____________________________ Date:- Friday 3 September 2010

Please write your name clearly on the back of your cheque, which should be payable to "Friends of Bursledon Brickworks".
Your signature will taken as permission to store your details on a computer database.
Please return this form and your cheque to:-
The Secretary, Friends of Bursledon Brickworks, Coal Park Lane, Swanwick, Southampton, SO31 7GW.



Don't forget to sign it and enclose your cheque, before posting.