AIA : Membership Application Form

The AIA's membership is administered by Maney Publishing on our behalf. An on-line application will be available in due course. In the meantime please print out this form, complete it and send it with payment to:
Janet Hague, Maney Publishing, Suite 1C, Joseph's Well, Hanover Walk, Leeds LS3 1AB, UK

If you are a UK tax payer we would appreciate it if you are able to complete and enclose a Gift Aid form also.


Please enrol me / us / my organisation as a member of the Association for Industrial Archaeology in the category shown below:


I / We acknowledge that in the event of the winding up of the AIA I / we will be liable for an amount not exceeding £1.00.

Title First name Surname
Organisation (if any)
Address
Town / City Telephone
State (not UK) Email
Post / Zip Code
Country Date

Signature

Please send a direct debit authority (UK bank accounts only)

I enclose payment by sterling cheque for £...................... payable to Maney Publishing
or
Please debit my Visa/MasterCard/AMEX/Switch card

Card Number Card expiry

Authorisation code (Last 3 digits on signature strip) Issue No. (Switch only)

The Association for Industrial Archaeology is registered in England under the Companies Act 1948 (No 1326854) and the Charities Act 1960 (No 277511)
Registered Office: c/o IGMT, Coach Road, Coalbrookdale, Telford TF8 7DQ

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