Please print this page and fill out all sections. Detach the top section for your own records, and send the completed lower
section along with payment and a stamped & self addressed envelope to:

Graham Perry
D&EPG Membership Secretary
46 Rookery Road
Knowle
Bristol
BS4 2DT

Date Sent:......../......../.......     Amount Paid:.......................



--------------------------------------------------------------------------------


DIESEL AND ELECTRIC PRESERVATION GROUP
Membership Application Form
Please complete in BLOCK CAPITALS



I would like to become a member of the Diesel and Electric Preservation Group



Title:


Mr / Mrs / Miss / Ms / Other:.....................................



Name:


...........................................................................



Address:
...........................................................................

...........................................................................

...........................................................................

...........................................................................

...........................................................................



Postcode:


..........................



Birthdate (if under 18):


......../......../........



I enclose:

£15 Senior Citizen

£18 Annual Adult Membership Subscription

£30 Joint Membership Subscription

£250 Life Membership (over 60)

Under 16's are free.


Please make cheques payable to the Diesel and Electric Preservation Group Ltd.

I would like to make an optional donation of:

..........................


I confirm I am tax payer and as so, I wish the Group to treat all donations & subscriptions I make as Gift Aid Donations
until i notify the Group otherwise. (Please tick box if applicable) [ ]


Signature:........................................      Date:......../......../.......


Thankyou for your support