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Cumann na Scríbheann nGaedhilge

IRISH TEXTS SOCIETY

APPLICATION FOR MEMBERSHIP

Type of Membership:

Individual

Full Library:

Circulation Library:

 

To: The Honorary Secretary

Date:______________________

Name (If applicable, Name of Library): ______________________________________________________________

Address: _______________________________________________________________________________________

________________________________________________E-Mail:_______________________________________________

Libraries please complete, Authorised by: _____________________________________ Date:______________________

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Payment of Full Membership Subscription and Order for Volumes

Volume numbers: ________________________________________________________________________________

If you wish to pay for future annual subscriptions by Bankers Order, please tick the box and the appropriate form will be sent to you.

(Only complete the following if different from information given above or if you are an existing member).

Name: ______________________________________________________________

Address: ____________________________________________________________

____________________________________________________________________

We enclose herewith Cheque / Bank Draft in the amount of _______________ re the above order.

Please debit our Credit Card.

Number: ___________________ Exp. Date:______________ CV2 No:_________________*

Visa

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Eurocard

Mastercard

Signature: _______________________________

* CV2 Number is the last 3 digits above the signature stripe and only applies to Visa & Mastercards which bear these 3 digits. If number is not on card or is illegible please indicate in the space provided.