MILLGATE, NEWARK

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MILLGATE CONSERVATION SOCIETY
Enrolment Form for the year July 2015-June 2016



Name.....................................................................................................................
Address
...............................................................................................................................

              ............................................................................................................................... Tel No...........................................................

I wish to enrol as a Resident Member/Friend of the Society  (please circle your choice)

E-mail address..................................................................................................................(fill in here in upper case, but we will assume lower case unless otherwise indicated

I enclose a donation of   ........     Signed.................................................................  Date...........................
Please make cheques payable to "Millgate Conservation Society"

Please send the completed form to:
Jane Williams, MCS Membership Secretary,  1 Navigation Yard
Newark Notts NG24 4TN