Form test

Name (required)

Address (for delivery of the Kipling Journal) (required)

Address line 2

Address line 3

Postcode/Zipcode (required)

Country of residence (required)

Telephone number

Email address (required)

Institute where studying (if applying for student rate)

How did you hear about the Society?

Choose one option (required)
Cheque (made payable to ‘The Kipling Society’)PayPal (via the Society's website)Standing Order (please ask the Membership Secretary for a Standing Order Mandate form)Bank Transfer to the Kipling Society’s bank account: 00114978, sort code: 30-96-24 - IBAN: GB18LOYD30962400114978 ‑ BIC: LOYDGB21014

Data protection (required)
The Society will hold my name, address, telephone number, email address and subscription details for the sole purpose of maintaining a record of my membership, for Society correspondence and for delivery of the Kipling Journal. My name, county/state and country of residence will be printed in a list of new members in the Kipling Journal after my membership commences.

I agree to the above data protection statement:
Yes

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