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APPLICATION FOR MEMBERSHIP
| Title |
First Name |
Surname
|
| Address
|
| Tel.
No. |
e-mail
address |
| Brief
details of your interest in Max
|
|
Signed
Dated
|
* Membership
rates for the year 1 February 2008 to 31 January 2009
Make a copy of this application
form, complete and post together with a cheque for £..............* made
payable to The Max Miller Appreciation Society to
 Jack
Strutt, 111 Brentwood Road, Brighton, BN1 7ET,
England
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