Pacific Islands Society
of
the United Kingdom and Ireland
Membership Application
I/We wish to join the Pacific Islands Society of the United Kingdom and Ireland as:
an individual [ ] a family [ ]
a UK student [ ] a serving VSO [ ]
a Pacific Islands Student [ ]
Mr/Mrs/Ms/ Other title____
Name(s) (BLOCK CAPITALS)______________________________
Address _________________________________________________
________________________________________________________
_________________________________ Postcode_______________
Telephone ________________________________
E-mail____________________________________
Pacific connection/country ____________________________________
________________________________________________________
I enclose a Cheque/Postal Order/Money Order for:
Subscription £ _______
Donation £ _______
Total £
_______
I request a standing order mandate form [ ]
Signed____________________________ Date____________________
Please send to the Membership Secretary:
Mrs.
Dorothy Prince, 3 Wood Street, New Bradwell, Milton Keynes
MK13
0AZ, United Kingdom