xii 



FORM B. 



Sir, 19 . 



I have tbe pleasure to inform you, with reference to- 

 your application dated the , that you have 



duly been elected a of tbe Victoria Institute, ok 



Philosophical Society of Great Britain. 



I have the honour to be, Sir, 



Your faithful Servant, 



To Sec. 



FOUM C. 



{Banhers) Messrs. 



* Please pay Messrs. Barclay & Co., 1, Pall Mall East, S.W., 

 my Annual Contribution of Two Guineas to tbe VICTORIA 

 INSTITUTE, due on the 1st of January, 19 , and tbe same 

 amount on that day in every succeeding year, until further notice, 



I am. 



Your obedient Servant, 



.19 



If this Form be used, please add your Signature, Banker's Name, and the 

 Date, and return it to the Office. 1, Adelphi Terrace House, W.C . Receipt- 

 stamp required. 



* The above is the form for Members. The form for Associates is the same 

 except that the Subscription stands as " One Guinea." 



