Kipling Society
Registration Form

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Do not press Return until you are ready to send the form.

Please enter your surname:
first name:
title (Mr/Mme/etc..):
degrees/professional qualifications:
date of birth (if under 23)
address - line 1:
address - line 2:
address - line 3:
country:of residence
telephone number:
email address:
proposed username:
proposed password:
confirm password:

Are you already a member of the Society: Y/N ?

Have you already paid your subscription by PayPal: Y/N ?

The annual subscription is 29.00 (UK), 31 or 43 (Europe), or for the rest of the world 31 or $US48.00. If you are outside Europe, will you need the Journal by airmail, at an extra cost of 4.00 or $US6.00: Y/N ?

I agree to my name, address, telephone number, e-mail address and subscription details being held on computer for the sole purpose of maintaining a record of my membership, for Society correspondence, and for delivery of the Kipling Journal: Y/N ?

How did you hear of the Kipling Society ?

Special interests ?