Membership Application

of the
Canal Card Collectors Circle
(affiliated to the Inland Waterways Association)

Instructions for this application.

1. Print this form using your printer. Usually you need only click your browser print button.

2. Complete the information requested. (We respect your privacy. The information you supply will be kept in strict confidence. Membership data is used only to service the membership of the Circle.) Your name and hometown will be listed on our Internet Membership Roster unless you indicate that you do not wish to be included.

3. Mail the completed application, along with your subscription (annual dues) to our Membership Secretary:

Ian Wilson
18, Kilpatrick Way, Yeading
Hayes, Middlesex UB4 9SX
ENGLAND, UK
 Note: If you are mailing this application
from the United States, be advised that
extra postage is required for mail going
to the United Kingdom.

Subscriptions for 2002 are £7.00 or US$14.00


Application Information
Date _____________________________
Surname _____________________ First Name ____________________
Address __________________________________________________________
__________________________________________________
Postcode (Zip) _____________
Country ________________
Telephone number ___________________________________________

Please indicate your particular interests - ring (circle) all appropriate answers:

Type cards you collect: Old | Modern | Both Location: English | Welsh | Scottish | American
Do you?: Buy | Sell | Exchange/Trade Canal type prefered: Narrow | Broad
Special interests: ____________________________________________________________
How did you hear of the Circle? Internet | Magazine | Newspaper | Member | other
Where did you get this form? Internet | Magazine | Newspaper | other

Do not include me on the Internet Membership Roster.

Thank you for your interest in the Canal Card Collectos Circle.