Gift Form For Herb Society Membership

I hereby apply for ___________________________________________________

(give name of person receiving gift) to be admitted to Membership of the Herb Society as

Cheques and postal orders I enclose the first year subscription of £___________ 

Credit Card (Visa, Mastercard, or Eurocard) - sorry, but we cannot accept debit cards

Please debit the sum of £ __________ from my credit card.
Name on card _____________________            Expiry date    _______________________
Type of card  ______________________            Card No.      _______________________

Signature     ______________________             Date             _____________________

My details
Name         __________________________ 
Address    _____________________________________________________________
_____________________________________________________________________
Post Code __________________________   Tel. No.  __________________________
Email          __________________________

Details of the person receiving membership
Name         __________________________ 
Address     ___________________________________________________________
____________________________________________________________________
Post Code __________________________   Tel. No.  _________________________
Email          __________________________ (if known)

Please Send membership pack to (delete where not applicable)

• Me
• Person receiving membership
• Other - give details below

____________________________________________________________________
____________________________________________________________________
____________________________________________________________________

When do you want the membership package sent (delete where not applicable)

• As soon as possible
• To arrive shortly before the following date _____________________

Message
If you want us to include a message, please give this below

____________________________________________________________________
____________________________________________________________________

Where did you hear about the Herb Society? ______________________________________________________________________

Please Return the completed form with your payment to: The Herb Society, Sulgrave Manor, Sulgrave, Banbury, OX17 2SD

Data Protection Act 1998:  Personal data collected on this form will only be used for the purpose of the Herb Society administration and will not be disclosed to any external sources without your express written consent.

If you are seeking to join the society on your own behalf, please use the normal application form.