RENEWAL/
APPLICATION FORM 2018
Please complete this form and return it, together with your payment, to CLIS Membership Secretary,Janice Paine, 22 Queensgate Gardens, 396 Upper Richmond Road, Putney, LONDON, SW15 6JN. If paying electronically please email to
Please sign section 1 or section 2:
1. Member: I am aware of the Christian ethos of CLIS as given in the Statement of Faith [available on request or from website
Signed………………………………………………Date…………………………
2. Subscriber: I do not wish to be a member but wish to receive CLIS publications until further notice
Signed: ……………………………………………Date……………………….
CONTACT DETAILS
Title………Christian names: …………………………….Surname:…………………………
Qualifications (academic, LIS)…………………………………………………………………
Home address: …...... Postcode: ……………………………
Home email: …………………………………………………………….Home tel. ……………………………
Work email: ……………………………………………………………..Work tel. …………………………….
Age range [optional] □ under 30 □30-39 □ 40-49 □50-65 □ over 65
Involvement in library and information services (please tick all that apply)
□ Public□ Academic□ School□ Government□ Industry
□ Student□Retired□ Unpaid volunteer□ Other (please specify)
Place of work (students: please state college/university)
………………………………………………………………………………………………………
Job title/post held/course………………………………………………………………………...
Member of CILIP? Yes/No
How did you hear about CLIS? [optional]…………………………………………….
MEMBERSHIP/SUBSCRIPTION RATES
Joining Jan-April, Sept-Dec*Joining May-Aug
Full rate□ £30□ £20
Discount rate**□ £20□ £15
Student rate (eOnly)□ Free (Please state college/university/course above)
Overseas (outside Europe): Please add £5 for airmail postage
*Joining Sept-Dec: payment includes following year
** Discount rate applies to retired, unwaged, 2 people at same address (pp.)
PaymentMembership fee/subscription:£…………..
Additional donation (optional):£…………..
TOTAL AMOUNT:£…………..
Method of paymentplease tick/delete as appropriate
□ I wish to pay by cheque [payable to Christians in Library and Information Services]
□ I wish to pay by Paypal [see website] /
□ Standing order / Electronic Funds Transfer (see below)
A/c name: Christians in Library and Information Services. Sort code: 20-98-57. a/c no.: 00129917
Please turn over for important Data Protection information
Data protection:
The membership database is kept for producing address labels.It is used solely for the Association’s own purposes and is not shared with any other organisation.
Would you be happy to have your name and contact details shared with our members in our membership directory?
□ Yes please:
Please specify below which details you are happy to share:
Name & UK Region □Address □Telephone Number □Email □
Job/Work Position □
□ No thank you - do NOT include me in the Directory
□CLIS e-newsletters: Please tick if you wish to receive electronic-newsletters by emailabout 10 times a year
Your name, email address and general region of the UK where you live will be stored on our secure email system (Mailchimp). It will only be used to send emails containing group news and links to our eNewsletter, membership directory and the electronic version of our journal “Christian Librarian”. You can unsubscribe at any time.