Title & Surname

Maiden name, if  applicable

First names

…normally known as?

Address inc post/zipcode

Email address

Phone landline

Phone mobile

fax

d.o.b.

Which category? tick or mark clearly.

Individual
£6

Family / corporate
£8

Overseas
£10
Must be in £ sterling

For FAMILY membership, please list titles/names & email / contact addresses if different than above main details. If completing on pc, enlarge box to add info: if hand written, please write clearly in capitals on reverse of this sheet.

We vastly prefer standing orders, as they make admin so much easier.
Please fill in our standing order form and send on to your own bank.
If you wish to pay annually by cheque, please make it payable to “The Stockton Society”

DECLARATION

I wish to apply for membership of the Stockton Society. I understand that, if accepted, the above details will be stored on computer and used only for administration purposes, and in pursuit of the objectives of the Society, namely to promote and encourage the study of family histories of the surname Stockton. These details will not be given or sold to other organisations. I understand that contact details will be shared with other members unless I request otherwise.

Signed _______________________________________________ date _______________

Email to Cestrienne@googlemail.com or post to: Mrs Susie Stockton-Link, "The Leas", 28, North Road, Builth Wells, Powys, LD2 3BU