The Birmingham Pals Living History Association

Your Name *


Your Email *


Membership Type: *
Individual Membership (£15)
Family Membership (£25)

Membership Subscription Payment: *
I will pay by cash or cheque in person
I will pay by cash or cheque by post - please send details of The Pals address
I will pay by Bank Transfer (details are given on this page).

Address: *


Postcode: *


Mobile Number:


Landline Number:


Do you hold a Firearm or Shotgun Certificate:
Please select Neither Shotgun Certificate only Firearms Certificate only Both Firearms and Shotgun Certificates

Date of Birth if under 18 years old:


Title of Family Member 1:
Please select Mr Mrs Miss Ms Other

Name of Family Member 1:


Mobile Number of Family Member 1:


Email Address of Family Member 1:


Firearm or Shotgun Certificate holder - additional Family Member 1:
Please Select Neither Shotgun Certificate only Firearms Certificate only Both Shotgun and Firearm Certificates

Date of Birth if under 18 years old:


Title of Family Member 2:
Please select Mr Mrs Miss Ms Other

Name of Family Member 2:


Mobile Number of Family Member 2:


Email Address of Family Member 2:


Firearm or Shotgun Certificate holder - Family Member 2:
Please Select Neither Shotgun Certificate only Firearm Certificate only Both Shotgun and Firearm Certificate

Date of Birth if under 18 years old: