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Hon American representative: Richard Valentine 1109 Second Ave, Schenectady, NY 12303, USA. Telephone (518) 209-8052
Payment by Cheque payable to Richard Valentine ......cut here...........................................................

MEMBERSHIP FORM Please tick appropriate box [ ] I enclose a Cheque / Postal Order for $25 (Students $10) to cover this year's subscription [ ] I enclose a Cheque / Postal Order for $25 (Students $10) to cover next year's subscription, if paid after the issue of the September/October newsletter [ ] I enclose a Cheque for $360 to cover Life Membership Name ---------------------------------------------- Address ----------------------------------------------------------------------------- Telephone No. ----------------------------------------------
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......cut here........................................................... Payment by Banker's Order (If you have a British Bank Account) This form to be sent to your British bank ......cut here...........................................................

BANKER'S ORDER To the Manager Bank plc. Bank Code ------------------------------------------------------------------------------ Bank Address ------------------------------------------------------------------------------ Please pay on receipt of this form, and on 2nd January of each succeeding year to Barclays Bank plc. PO Box 41, 16 High Street, High Wycombe, Bucks, HP11 2BG (Sort Code 20-40-71) the sum of £ ___________ (subscription/donation in figures) for the credit of the Peter Warlock Society, Account No. 00709271, until further notice from me. Signature............................. Date............... Address ...................................................................