THE CORY SOCIETY  MEMBERSHIP FORM

We hope that you will become a member of the Cory Society by completing this form and returning it with your cheque, by post, to the Membership Secretary. We will not issue a receipt unless requested and 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.

PLEASE COMPLETE THE FORM IN BLOCK CAPITALS (including your E-MAIL
ADDRESS as lower case letters are sometimes difficult to read and problems have arisen in the past)

MR / MRS / MISS / MS / DR:    ………………….      MEMBERSHIP NO:  …….  (Renewal only) 

FORENAME(S):   ……………………………… SURNAME:  ……………………………………….

ADDRESS:  ……………………………………………………………………………………………………….........

……………………………………………………………………………………..…………………......

………………………………………………………………POST / ZIP CODE ……………………….
TELEPHONE NO. (INC. CODE):  ………………………………………………………………………………..

E-MAIL ADDRESS:

ADDITIONAL NAMES INCLUDED IN THIS MEMBERSHIP:

MEMBERSHIP FEE:  £12 (UK);  $27 (US); C$40 (Canada); A$40 (Australia) OVERSEAS MEMBERS MAY PAY INSTEAD, £15 STERLING BY BANK DRAFT VIA UK BRANCH OF BANK.

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.

I HEREBY APPLY FOR MEMBERSHIP OF THE CORY SOCIETY.
I ENCLOSE THE MEMBERSHIP FEE OF:  ………………... ..    CHEQUE NO:  …………………..

SIGNATURE :  .........................……............................……........  DATE : .............................……….

Your cheque should be made payable to:    THE CORY SOCIETY 
and sent with this form to the membership secretary, MRS ROSEMARY GITSHAM,

17 GRIMSTON LANE, TRIMLEY ST MARTIN, FELIXSTOWE, SUFFOLK, IP11 0RU (U.K.)

PLEASE COMPLETE BELOW THE NAME OF YOUR EARLIEST  CORY ANCESTOR:
To aid with identification
: Cory tree/table ref:            OR complete the details below where known.
BIRTH/BAP: DATE & PLACE: 
DEATH/BURIAL: DATE & PLACE
DATE OF MARRIAGE:  DATE & PLACE:                                            SPOUSE:

UPDATES ON MY FAMILY:    If you have had new additions to your family or discovered any new ancestors that you would like to have mentioned in the next newsletter, please tell us overleaf.
THE
CORY SOCIETY DNA PROJECT:  If you are a Cory male, or know of a Cory male, whose DNA has not been tested and would like further information please TICK HERE :

Home Page  |  Who We Are  |  Publications  |    DNA Project   |  Event Calendar  |