Annual membership from 1^st January to 31^st December.
Anyone joining after October 1st receives free membership for the following calendar year.

NAME……………………………………………………Mr/Mrs/Miss/Ms/Title…………

ADDRESS…………………………………………………………………………………

…………………………………………………………Post Code………………………

PHONE NUMBER……………………………………E-MAIL……………………………

Date…………………………………

Please select membership category:

Please make your cheque payable to CVAHS

Special Interests

Members are welcome at all talks and meetings of the society and receive a free annual copy
of the CVAHS Journal. If you would also like to take part in our archaeological surveys and
digs, please tick the Field Group below. If you would like to help with historical (documentary)
research please tick the Records Group.

IMPORTANT: Field Group activities are announced by email, so please ensure you enter a current email address on this form.

GIFT AID DECLARATION

If you are a UK tax payer please GIFT AID your subscription by signing again below.
This enables us to reclaim the tax direct from the Inland Revenue at no cost or
inconvenience to your self and provides an extremely valuable source of income to the Society.

I am a UK tax payer and wish all my subscription from the date of this declaration to be
treated as GIFT AID until I notify you otherwise.

Signature…………………………………………… Date…………………………………

Please return your completed membership application form and cheque to:

Julia Plaistowe, Chesham Bois House, 85 Bois Lane, Amersham, Bucks, HP6 6DT