Xll 



FORM B. 



Sir, 19 . 



I have the pleasure to inform you, with reference to 

 your application dated the , that you have 



duly been elected a of the Victoria Institute, or 



Philosophical Society op Gtreat Britain. 



I have the honour to be, Sir, 



Your faithful Servant, 



To So7i. St 



FOUM C. 



(Bankers) Messrs. 



* Please pay Messrs. Ransom, Bouverie, & Co. my Annual 

 Contribution of Two Guineas to the VICTORIA INSTITUTE, 

 due on the 1st of January, 19 , and the same amount on that 

 day in every succeeding year, until further notice. 



I am. 



Your obedient Servant, 



.19 



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

 Date, and return it to the Office, Adelphi Terrace. Receipt-stamp required. 



* The above is the form for Members. The form for Associates i.s the same, 

 except that the Subscription stands as " One GrTJiNEA." 



