British Society of Catalunya EmpordÀ


On-line Membership

Membership Application
on-line request

Complete this form and
Press the 'Submit' button to send it to us;
pressing "Reset" will clear any entries you have made.

If paying by cheque, see the 'Membership Info.' page for payee information and to whom and where to send the cheque. Don't forget to enclose your name and address with the cheque so that it can be linked to your on-line application. You will also be able to choose what style of magazine you want.

First name*:
Last name*:
Email address*:
Work phone number:
Fax number:
Home phone number:
Mobile phone number:
Address line 1:
Address line 2:
State / Province / Region:
ZIP / Postal code:
Select method of payment:
Select Magazine Style(printed or electronic):

This web form is protected from SPAM by
Enter web form code*: Web Form Code
Please enter the phrase in this image into the web form code box to its left.

* - required fields.