AIA : Membership Application Form

Please print out this form, complete it and send it to:

AIA Liaison Office, The Ironbridge Institute, Ironbridge Gorge Museum, Coalbrookdale, Telford TF8 7DX, UK


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


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

I enclose payment by sterling cheque for £......
or
Please debit my Visa / Mastercard / Eurocard account

Card Number

Card expiry Name of card issuing bank

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.

Signature
Name
Organisation (if any)
Address
Town / City
County / State
Post / Zip Code
Country
Date


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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