Polperro Family History Society

Founded 2002

Membership Application Form

Please complete the form below and return to: Jeremy Johns, The Crown House,
Clifton-upon-Teme, Worcestershire, WR6 6EN, UK.

Mr/Mrs/Miss/Ms………………………………………………………………………

FULL NAME:……………………………………………………………...................

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

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

POSTCODE:………………….................TELEPHONE:……………………………

E-MAIL ADDRESS:………………..................………………………………………

INTEREST:…………………………..................……………………………………..

Your research interest will be listed in the Members’ Directory.
Do you wish your e-mail address to be included as well? YES / NO

Membership Category - please circle

Please make cheques payable to Polperro Family Historians