Printable Application Form

Please print, complete and return this form with a cheque made payable to "HMS Trincomalee Trust" to
The Friends of HMS Trincomalee,
P O Box 1817, HARTLEPOOL, TS24 7YE.

Annual Membership Subscription
ADULT £20.00 CONCESSIONARY £15.00
JOINT ADULT £30.00 JOINT CONCESSIONARY £22.50
FAMILY (2+3) £45.00

Concessionary Membership applies to children, students and those unwaged.

Your details:

Title:

Surname:

First Name:

Address:

Post Code:

Telephone:

e-mail:

I wish to apply for the following Membership:

Membership category:

Subscription: £

Names of any additional members if applying for Joint or Family Membership:

Membership Total: £

Donation: £

Total enclosed: £

Signed:

Date:

I agree that this subscription may be made under the Gift Aid Scheme ____ (tick)