Membership Application for
The House of Isis and Osiris

The following forms of membership of The House of Isis and Osiris are available:

Complete the following form and send (including the appropriate payment) to:

The House of Isis and Osiris
BCM 6812
London
WC1N 3XX
England

Note that changes in status can only be recorded at the point of annual renewal.

Please tick one box as appropriate.

 _
|_|  I wish to apply for membership of The House of Isis and Osiris as
     an Associate Member. (£7.50)
 _
|_|  I wish to apply for membership of The House of Isis and Osiris as
     a Full Member. (£10.00)
 _
|_|  We wish to apply for joint membership of The House of Isis and Osiris
     as Full Members. (£15.00)

 Forename(s): ____________________________________________________________

  Surname(s): ____________________________________________________________

     Address: ____________________________________________________________

              ____________________________________________________________

   Town/City: ____________________________________________________________

      County: ____________________________________________________________

 Postal Code: ____________________________________________________________

     Country: ____________________________________________________________

   Telephone: ____________________________________________________________

      E-mail: ____________________________________________________________

Signature(s): ____________________________________________________________

        Date: ____________________________________________________________


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