APPLICATION FOR MEMBERSHIP

Please send this form to:-

 The Treasurer,

Ulster Place-Name Society

Celtic Studies

School of Modern Languages

The Queen's University of Belfast

Belfast BT7 1NN

Tel: 028 9027 3689  Fax: 028 9033 5298 

Please process this application for membership of the above Society for the year ending....................... .I /We enclose cheque for £10.00  /€16.00 (please delete as appropriate)  being the subscription due. 

Please make cheques payable to Ulster Place-Name Society.

Mr/ Mrs/ Miss/ Ms/ Dr/ Prof...............Name.............................................................................................................     

Address.................................................................................................................................................................

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Post /Zip Code.....................................................

Signature...................................................................................................Date...................................................