Xll 



FORM B. 



Sir, 19 . 



I have tbe pleasure to inform you, with reference to 

 your application dated the , that yon have 



duly been elected a of the Victoria Institute, oh 



Philosophical Society of Great Britaix. 



I have the honour to be, Sir, 



Your faithful Servant, 



To Hun. Sec. 



FORM C. 



(Banhers) Messrs. 



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

 Contribution of Two Guineas to tbe 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 this Form be used, please add your Signature, Banker's Name, and tbe 

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



* Tbe above is tbe form for Members. Tbe form for Associates is tbe same, 

 except that tbe Subscription stands as " One GtUINEA." 



