MEMBERSHIP APPLICATION: Please type in details on screen, print out, sign and return with remittance to:
MERG Membership Secretary,
40 Compton Avenue
Poole
Dorset
BH14 8PY
(NB. form required to be signed and sent in even if payment is by Paypal).

FIRST NAME:   
LAST NAME:

ADDRESS 1:
 
ADDRESS 2: 
ADDRESS 3: 
TOWN/CITY:       
COUNTY/STATE:
COUNTRY:                 TEL No:    
POST CODE/ZIP: EMAIL:  
HOW DID YOU HEAR OF MERG ?

I live inside the EU and enclose my Cheque/PO No. for the sum of  £17.00  or I have paid £18.00 by Paypal using reference .
I live OUTSIDE the EU and enclose my Cheque/PO No.for the sum of  £20.00, or US$40.00 or I have paid US$43.00 or the equivalent of £21.00 by Paypal using reference .

Cheques should be drawn on a UK Bank and  made payable to ‘MERG’  or on a US bank made payable to Brian Martin. 

I agree to abide by the Rules of the Group and I confirm that I am 18 years of age or over. By applying for membership of MERG I consent to the data supplied on the application form being used for the promotion of MERG’s aims and for membership administration purposes. I understand that the data will be included in a Membership List that is provided to other members. Once a year the list may also be viewed on the password protected members only area of the MERG website. I understand that the Membership Secretary will hold my details on a computer.  I understand and accept that my data and that of other members may not be used for any commercial purpose. Should I not renew my subscription, my full name and membership number will be retained, for the purpose of allowing the re-allocation of the same number if I rejoin at a later date, other membership data will be deleted 24 months after last renewal.  Members are responsible for advising the Membership Secretary of any changes in their data.
I also agree to indemnify MERG, its Officers and Members against any claim arising from any use or misuse of any publication, kit or other goods supplied to me by MERG.  


SIGNATURE _____________________________DATE

For MERG Administration purposes only
Date received Cheque, PO, Cash Date entered Banked Ref. Vouchers Mem No.
           

Web response - form revised 08/05/2008