Your Name (required) Your Email Your Telephone Number Membership Type —Please choose an option—Individual - €15Family - €25 Application or Renewal —Please choose an option—ApplicationRenewal Subscription Year (Subscription year runs from 1st January) I give permission for CHAS to contact me by telephone, email and direct mail I wish to have my name and address included in the membership list printed annually in Carloviana I hereby apply for renewal/membership of the Carlow Historical and Archaeological Society and agree to be bound by the rules thereof. Δ