APPLICATION FOR MEMBERSHIP

I / We wish to become members of the Staffordshire & Birmingham Agricultural Society.

Name ........................................................................................................

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

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

Post Code .........................     Telephone No ...........................................

Please tick the type of Membership you require:

	Single Membership	£20 inc. VAT
	Joint Membership	£30 inc. VAT
	Family Membership (includes two adults and up to three children under the age of 16)	£35 inc. VAT
	Governor (includes two adults)	£50 inc. VAT
	Governor  & Family (includes two adults and up to three children under the age of 16).	£55 inc. VAT
	Staffordshire Young Farmer's Club Member	£5 inc. VAT

I wish to pay my subscription (due on 1st January each year) by:

*Direct Debit Mandate (Attach completed mandate to this form and return to the office) *Cheque  (Made payable to Staffordshire & Birmingham Agricultural Society) Payment by Direct Debit attracts a discount of £2 for all membership categories with the exception of the SYFC Membership)

*Please delete as appropriate