Membership Application 2017

Name *

Name

First Name

Last Name

Nick Name

Rank(s) / Rates(s)

Date served on board from

Date served on board from

MM

DD

YYYY

Date served on board to

Date served on board to

MM

DD

YYYY

Address

Post Code

Telephone

Email

Associate Membership Application 2017

Name *

Name

First Name

Last Name

Address

Post Code

Telephone

Email

Please give your reasons why you should be considered as an Associate Member of the HMS Jupiter Association *

New Membership fees are £10 until December 31st 2017

Bank Details: Account No. 471795 : Sort Code 30-91-12.

Please make all cheques payable to:

The HMS JUPITER ASSOCIATION and send to the Treasurer: -

Mr. B. Holland

The HMS Jupiter Association

119 Bradford Road

Riddlesden

Keighley

W. Yorks.

BD20 5JH