DONIZETTI SOCIETY

Membership Subscription Renewal for addresses in the UK,
beginning April ______

Your membership renewal is now due. It is a help to the Society if you renew promptly. Please print off and send this form to the Donizetti Society Secretary: Mr. Pip Clayton, 146 Bordesley Road, Morden, Surrey SM4 5LT, UK, telephone 020 8648 9364.

Title and Name

  

 

 Address

(if changed)

 

 

  

I would like an annual membership (£18) _____ / three year membership (£50) _____ . (Please tick as required).

Cheques in sterling should be made out to "Donizetti Society".

If you wish to pay by credit card then please include below your credit card number, expiry date and security number (if your card has one). Our card clearer now requires the security number if there is one.  The information is destroyed once the payment has gone through.

Card type,

delete as applicable

                  Visa                                    Mastercard               

Card no.                                                                                                 Expiry date                  

 

 Security number    ......................

(usually the last 3 numbers on the signature block on the  back of the card.  Please note it is NOT your pin number)

Thank you