APPLICATION FORM FOR MEMBERSHIP 

If you wish to join/rejoin the Cory Society please print this page and send by post to the Membership Secretary. No receipt will be sent unless return postage is enclosed. (Please allow up to 14 days for processing.) One membership subscription may include all people living at the same address, listed by the main member's name, receiving only one set of papers and having one vote.                         Return to HOME page

 MR / MRS / MISS / MS / DR :

 RENEWALS: TICK OR MEMBERSHIP NO. 

 FORENAME(S):  

  SURNAME:
ADDRESS: 

POST / ZIP CODE :

ADDITIONAL NAMES INCLUDED IN THIS MEMBERSHIP :

  

 

 

TELEPHONE NO. (INC. CODE): 

E-MAIL ADDRESS:
MEMBERSHIP FEE: UK £12; US  $27; Canadian C$40; Australian $40; NZ $43. 

OVERSEAS MEMBERS MAY PAY INSTEAD, £15 STERLING BY BANK DRAFT VIA UK BRANCH OF BANK. 

YOUR CHEQUE  SHOULD BE MADE PAYABLE TO: THE CORY SOCIETY 
AND SENT WITH THIS FORM TO THE MEMBERSHIP SECRETARY,

I HEREBY APPLY FOR NEW/RENEWAL MEMBERSHIP OF THE CORY SOCIETY.  I ENCLOSE THE MEMBERSHIP FEE OF:                    
CHEQUE NO:

MRS ROSEMARY GITSHAM,   
17 GRIMSTON LANE, 
TRIMLEY ST MARTIN, FELIXSTOWE, 
SUFFOLK, IP11 0RU   (UK)

SIGNATURE :   ........................................................  

DATE : ................................

PLEASE HELP US KEEP OUR RECORDS UP TO DATE. 
MY EARLIEST KNOWN CORY ANCESTOR:
BIRTH/BAP:                                                                     DATE:
DEATH/BURIAL:                                                            DATE:
MARRIED:                                                                        DATE:
I AM INTERESTED IN THE CORY DNA PROJECT.
I WOULD LIKE TO AID RESEARCH BY:  
                                                                                          (FOR MALE CORYS ONLY)
                                           Cory tree/table reference if known:
AT: 
AT:
AT:
I WOULD LIKE A LEAFLET              ...................
ENCLOSING A DONATION OF        .....................
VOLUNTEERING TO TAKE A DNA  TEST  ............
FOR NEW MEMBERS ONLY:
HAVE YOU ALREADY CONTACTED THE SOCIETY? 
IF YES, WITH WHOM HAVE YOU BEEN CORRESPONDING?		 Unless you specifically ask not to be included, please note that your details given above and the branch of the family to which you belong, will be published in our Annual Membership Directory for circulation to the membership and information on new members will be included in a newsletter.  Your details will be held on computer, for Society use only, unless you ask for your record to be deleted.