The Scalefour Society Membership Application Form

SCALEFOUR SOCIETY - APPLICATION FOR MEMBERSHIP

The Committee reserves the right to decline any application. Form revised 25/5/08

For Society use only:

NUMBER:

Title (Mr, Mrs, Dr.etc.):		Initials:	Surname:
Forename(s):
Address:
Town/City
County/State
Country:				PostCode/Zip:
E-mail address:
Telephone Number:			Date of birth (eg 01 JAN 1975):
	(DOB is required for subscription rate validation).

DATA PROTECTION ACT 1998 - It is a condition of membership that the Society may act as a Data Controller in respect of the personal data of its members. The provisions of the Act which relate to an Unincorporated Members Club apply. The personal data of each member may be used for all or any of the following purposes. a) mailing list(s) for distributing, or recording the distribution of, publications, articles, and information to members. b) the production and publication of a membership list to members of the Society for use only within the Society. c) disclosures to computer operator(s) and/or servicer(s) when required to repair/maintain equipment and/or programmes.
Right to Non-Disclosure. A member may elect to have certain details excluded from the published list - see b) above - If so, please indicate which items you wish to remain private by ticking the relevant box(es) below.
EXCLUDE FROM LIST: FORENAME(S) ; ADDRESS ; TELEPHONE NO. ; E-MAIL ADDRESS

I hereby apply for membership of the Scalefour Society and I agree, if elected, to abide by the Rules of the Society as laid down in the Constitution. I consent to my personal data, as given above, being held and used by the Society for purposes authorised by the Data Protection Act 1998. My signature also authorises the charge to my Credit Card where specified.

Signature_______________ _________________________Date (eg 01 JAN 2005)

I enclose a cheque made payable to The Scalefour Society to the value of    , or have completed the Credit Card Payment section, this comprising my joining fee and first subscription.
(Please note: Cheques must be in £ sterling (GBPds) and from a UK Bank account)
For Payment by Credit Card: Visa, & Mastercard accepted - select option below.
Please debit my      Card Number     Expiry Date (eg 05-09)
Name of card issuing organisation (eg MBNA, Lloyds, TSB etc.)
Cardholders name (exactly as shown on Card