Mapa Scotland

The campaign to restore General Maczek’s

Great Polish Map of Scotland

http://www.makers.org.uk/place/Maczek

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