MAPA SCOTLAND

The campaign to restore General Maczek’s

Great Polish Map of Scotland

www.mapascotland.makers.org.uk

All proceeds will be used towards material restoration of the Great Map and its promotion.

Membership Application Form

Names:________________________________________________________

Address: _______________________________________________________

_______________________________________________________________

Phone: ________________________________________________________

Email: _________________________________________________________

Subscription: __________________ Donation (optional): ______________

May we seek Gift Aid on your contribution? YES/ NO

Signed: _____________________________________

Payment may be made by cheque to ‘Mapa Scotland’ or by Internet Banking (Lloyds Bank, Sort Code 30-71-84, Account Number 17186768, Mapa Scotland). If you pay by Internet Banking PLEASE REMEMBER TO ADD YOUR NAME AS A REFERENCE so that we can identify payments.

Membership categories and annual subscriptions:

Individual: £10 Family: £15 Voluntary group: £20 Public body: £50

Contact: Keith Burns, Secretary, 01620 860257,

Mapa Scotland,

21 The Dean,

East Linton,

East Lothian,

EH40 3ED or to mapascotland@gmail.com