MEMBERSHIP FORM FOR THE YEATS SOCIETY SLIGO

Please complete, print and return the following form to: Membership, Yeats Society Sligo, Yeats Memorial Building, Hyde Bridge, Sligo, Ireland.

(Please note that the Yeats Society does not have secure internet transaction processing facilities).

Name:
Address:
Country:

Telephone:
Email:
Annual Membership Category:
  Individual 25 Euro   
Family (2 people) 40 Euro
Unemployed / Student 15 Euro
Please enclose payment by cheque or by postal order made payable to Yeats Society Sligo, or by VISA or MASTERCARD.
 

VISA    MASTERCARD

Credit Card No:
Expiry Date:
Cardholders Name:
Cardholders signature: