Membership Application Form

Surname

Christian Names
House Name / #
Street Name
City or Town
County
Post Code
Country
Telephone
Mobile
Email Address

  @  

Memership         Full   Associate Family 10 Single 5

               Overseas              Family 12 Single 7

Mines worked / when

I have read and accepted the Cornish Miners Constitution

 

Signed -----------------------------------------------------    Date -----/-----/------

Please make cheques payable to :- "Cornish Miners Association"
and post to the Membership Secretary:- 
Mr KP Bray,
70, Raymond Road,
Redruth,
Cornwall. TR15 2HF

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