Membership Application Form

JACQUES OFFENBACH SOCIETY
Richard Duployen
Flat 1 E, Laburnum Place
1 Forest Road
Risinghurst
Oxford OX3 8LF

Telephone:01865 762650
e-mail: richardduployen@mail.com

I wish to enrol / renew membership of the Jacques Offenbach Society and enclose my membership fee of:

  20.00 sterling for UK OR
  €25.00 for countries within the E.U,
  25.00 sterling for all other countries, or
  $40.00 U.S. which may be sent to the above address or to our U.S. coordinator:
      (Robert L. Folstein, 4885 West Maple Leaf Circle, Greenfield, WI 53220-2784)

Payment may be by U.K. cheque made payable to "The Jacques Offenbach Society" or by banknotes in any currency but preferably Sterling, Euros or U.S.Dollars, as the charges for changing small amounts of currency are considerable.

Don't forget the concession of 50% if you are a student or a retired person.

Name: _________________________________________________________________________________
 

Address: _______________________________________________________________________________
 

________________________________________________________________________________________
 

________________________________________________________________________________________
   

Signature: ______________________________________________ Date: _________________________

Please e-mail rduployen@london.com if you have any questions about joining the Society

Richard Duployen
Flat 1 E, Laburnum Place, 1 Forest Road
Risinghurst, Oxford, OX3 8LF