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: £12 Senior Citizen £15 Annual Membership Subscription £25 Joint Membership Subscription £250 Life Membership (over 60) 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