MEMBERSHIP APPLICATION

Name ………………………………………………………………………………..

Address……………………………………………………………………………….

………………………………………………………………………………………..

Post Code…………………..

Telephone Number…………………………………..

Single membership……………………………..          £5.50

Joint membership……………………………….         £10.50

Additional member at same address……………          £5.00

Corporate membership…………………………         £25.00
(Businesses, firms, schools and colleges, etc.)

Cheques to be made payable to “Cockermouth & District Civic Trust.

Please print off and send to:      Ian Dodsworth, Hon Treasurer,
                                                Cockermouth & District Civic Trust,
                                                1 Banks Court,
                                                Market Place,
                                                Cockermouth,
                                                CA13 9NG

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