APPLICATION FORM

Please complete and return to:
Mr W Johnson
25 Ashworth Lane
Mottram in Longdendale
Cheshire, UK
SK14 6NT
tel: 44(0)1457 763 555

Please enclose £10.00 plus £3.00 postage and packing UK
Europe £10.00 plus£5.50 postage and packing.
Australia and North America £10.00 plus £10.00 airmail or £5.00 surface mail.

Name .........................................................................................

Address .....................................................................................
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Post/Zip code..............................................................................

tel: .......................................................................................
e-mail: .........................................................................................

Date ............................................................................................
Signed ........................................................................................

All Cheques (Sterling only) payable to the TAMESIDE LOCAL HISTORY FORUM

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