Application Form

Please fill in and print out this form – then post it with your subscription to:

The Membership Secretary
Worcester Birmingham and Droitwich Canals Society
82 Longboat Lane
Stourport on Severn
DY13 8AE

Please enrol me as a member of the society.

I/We agree to abide by the Constitution and Rules of the Society

Full name
Address
Postcode
Country
Telephone
Mobile
Email
Rate
Gift Aid As a tax payer, I agree to WBCS reclaiming Gift Aid Refund on my subscriptions and donations to the
Society. Please tick
Donation (optional but with increased postage rates always welcome)  
For  overseas membership, please contact membership@wbdcs.org.uk for current rates.
Your interests Please select as many as apply Waterways generally  The built heritage

Wildlife/Conservation  History

Other (please specify)

How do you use the canal? Please select as many as apply Angling Boating Canoeing Cycling Walking
Signature
Date
Your monthly magazine ’58’ can be supplied in the following formats Please select as many as apply via post via email both