Membership Application: Your Details

Membership Application

A number of the fields below are required and have to be completed – these are marked with a ‘*’.

Information about how to complete a field may be shown by clicking the ‘?’ at the end of the field, if there is one.

Please note: you cannot use this form to renew an existing membership.

Membership Level change

You have selected the Student membership level.

The price for membership is £4.00 now.

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Account Information Already have an account? Log in here

Username

This is the name you can use to log onto your account. Please use your email address as your Username. If you do not have an email address, you cannot apply via these online pages.

Password

For your own security, please use a strong (difficult to guess) password.

Confirm Password

E-mail Address

Confirm E-mail Address

Full Name LEAVE THIS BLANK

Please make cheques payable exactly to Hexham Local History Society and post to the Membership Secretary whose address in on the Contact Us page of the HLHS website

Title

Known As

Newsletter

It is easier and more cost effective for us to send newsletters by email, but we can send it by post if necessary.

Newsletter Delivery Method Via Email Via Post

Announcements Subscribed Unsubscribed

We may occasionally wish to contact you about items not associated with your membership but which we think may be of interest to you. If you would prefer not to receive such communications, please click on the tick box.

Hexham Historian Delivery method Select method Via Post Hand Delivered

Gift Aid

Gift Aid? Select Yes or No Yes No

Payment Method Select a payment method Cheque Standing Order Cash Direct Bank transfer to HLHS

Hand distribution list membership number

User Notes

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