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Membership Application Form |
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Surname |
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| Christian Names | |
| House Name / # | |
| Street Name | |
| City or Town | |
| County | |
| Post Code | |
| Country | |
| Telephone | |
| Mobile | |
| Email Address |
@ |
| Memership |
Full
Associate
Family £10
Single
£5
Overseas Family £12 Single £7 |
| Mines worked / when | |
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I have read and accepted the Cornish Miners Constitution
Signed ----------------------------------------------------- Date -----/-----/------ |
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Please make
cheques payable to :- "Cornish Miners Association"
and post to the Membership Secretary:- Mr KP Bray, 70, Raymond Road, Redruth, Cornwall. TR15 2HF |
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