The Canal Museum Trust - Application for Membership

I wish to become a member of the Canal Museum Trust and agree to abide by its constitution. I am sympathetic to its objectives.

Name: ______________________________________________________________________________

Address: ____________________________________________________________________________

________________________________________________________ Postcode: ___________________

E-mail: _____________________________________________ Telephone: ________________________

> I enclose my annual subscription, (cheques etc. payable to “Canal Museum Trust”) as follows:

Signed: __________________________

Send to: The Secretary, Canal Museum Trust 12-14, New Wharf Road, London N1 9RT

Registered Charity No. 277484