City of Southampton Society
Registered Charity No 1006256 England and Wales
caring for our city's heritage and its green open spaces
Webmaster John Avery
                                      Titanic departing from Southampton April 1912          John Melody Town Crier          
   Home      Membership Form
Queen Mary entering KG DOCKOur outdoor visit to Minstead Church in 2011 image Will TempleWarrior who after service on the front in WWI became a Southampton Police Horse. Image by kind permission Bitterne Local History SocietySouthampton CenotaphJohn Melody Town Crier at Tudor Revels 2012 image Arthur Jeffery
copy and paste

Membership Application / Subscription Renewal Form                                    office use reference no        

Data Protection: the society uses names and addresses and other detail supplied by the applicant to provide members with notices of meetings, circulation of newsletters and information on projects. The society does not provide any personal details to outside bodies [unless directed by statute]

Membership Application: membership is open to all persons above the age of 16 years who supportive in the aims and objectives of the civic society.

Title                      Surname  

Forename[s]                                                                                                      family member name

Address                                                                                               Post Code

Telephone for contact [optional]                              

e mail for contact [optional]


Class of membership [please tick] Member £15     

Married couple /partners at same address £22-50 

Senior [60 plus] £12-50  Married couple /partners at same address [at least one over the age of 60] £20-00

Junior member 16 or over in full time education £5 [note this class may be discontinued at a future AGM]

Business £30  Not for profit organisation £20  Not for profit organisation with reciprocal arrangement - no fee 

delete as appropriate 

[a] I wish to become a new member [renewable on 1st March next] YES/NO

[b] I wish to renew my subscription YES/NO

[c] I wish to select the following means of contact from CoSS

[1] by post YES/NO [note if you select NO you will need to arrange to collect your copy of the Review and current membership card at a general meeting]

[2] by e mail YES/NO [e mail is sent to advise of subject and date of forthcoming meeting/s and any society news]

My e mail address is:

[3] by telephone YES/NO

My telephone no with dialing code is:

I wish and agree to receive correspondence as listed below:

[1] Notification of meetings and events YES/NO

[2] Notification to renew my annual subscription YES/NO

[3] Copies of the Review YES/NO

[These details required by EU directive from May 2018]


Additional signature of Family Member [if applicable]

Gift Aid At no cost to the individual tax payer the City of Southampton Society is able to re-claim income tax or capital gains tax paid by the member or donor by completing the following declaration:  

I pay enough UK income tax and/or capital gains tax to cover the amount of tax that the City of Southampton Society will reclaim from HM Revenue and Customs. If my tax circumstances change at a future date I undertake to notify the membership secretary of the City of Southampton Society. I wish all amounts paid in subscriptions and or donations commencing with this payment and all future payments to be treated as a Gift Aid donation to the City of Southampton Society.  In the event that my circumstances change and I am no longer liable to pay UK tax I undertake to reimburse HM Revenue and Customs any tax amount incorrectly claimed.


Signature                                                                                                           Name in full of taxpayer                            



 Post code                                                                                                             




[Please print the page by a right click on your mouse, you may wish to keep a copy for your records]

Please make a cheque payable to City of Southampton Society and after completing the form please send to Keith Balwyn,  CoSS Membership Secretary,        3 Stalbridge Drive  Ferndown  BH22 8HY

 home page



Outdoor visit to Minstead Church image courtesy Will Temple Outdoor visit on a Guy Arab open top busTug tender Calshot in preservation