Membership Application

Please fill out the form below, then print it and send it with your cheque or postal order made out to 'The Moredun Foundation' to: -

The Moredun Foundation, Pentlands Science Park, Bush Loan, Penicuik
Midlothian, EH26 0PZ.

I hereby apply for admission to membership of the Moredun Foundation

Full member
(Only full members are eligible to vote at AGMs)
£ 25 annual payment
£ 20 by Direct Debit (form here)
Student member
(Individuals in full time education)		 £ 10 annual payment
Overseas member
(Individuals living Outside the UK)		 £ 30 annual payment
Life member £500 one off payment
Title: (Mr/Mrs/Miss/Dr)
First Name:
Surname:
Date of Birth:

/ / (DD/MM/YYYY)
Occupation:
Email:
Home address:
Postcode:
Alternatively, you can pay by credit/debit card.
Please debit my Visa/Mastercard the amount highlighted above
Card Number (no spaces)
CSC (Last 3 digits on signature strip)
Expiry date / (MM/YYYY)
Signature