xii 



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 of Great Britain. 



I have the honour to be. Sir, 



Your faithful Servant, 



To -STcw. Sec. 



FOEM C. 



(Banhers) Messrs. 



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

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

 Date, and return it to the OfRco. Adelplii Terrace. 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." 



