Application for Membership

Subscription Rates for 2019 are:

Individual..................£10

Couple......................£20

Corporate...................£35

Individual Life Membership..£100

Please fill in the form below. It will be sent to the Membership Secretary who will get in touch with you shortly.

Please fill in all fields


"; die(); } $error_message = array(); $name = $_POST['name']; $address1 = $_POST['address1']; $address2 = $_POST['address2']; $address3 = $_POST['address3']; $email = $_POST['email']; $postcode = $_POST['postcode']; $telephone = $_POST['telephone']; $a1 = str_pad($address2, 20, " ", STR_PAD_LEFT); $a2 = str_pad($address3, 20, " ", STR_PAD_LEFT); $email_exp = '/^[A-Za-z0-9._%-]+@[A-Za-z0-9.-]+\.[A-Za-z]{2,4}$/'; if(!preg_match($email_exp,$email)) { $error_message = 'The Email Address you entered does not appear to be valid.
'; } $string_exp = "/^[A-Za-z .'-]+$/"; if(!preg_match($string_exp,$name)) { array_push($errors_message, 'The First Name you entered does not appear to be valid'); } if(strlen($address1) < 2) { array_push($errors_message, 'The Address you have entered does not appear to be valid'); } if(preg_match("/http:\/\//", $address1)){ echo'Thank you'; exit; } if(count($error_message) > 0) { died($error_message); } $todayis = date("l, F j, Y, g:i a") ; $subject = "Leominster Civic Society Application"; $message = " $todayis \n From: $name \n Address : $address1 \n : $a1\n : $a2 \n Post Code: $postcode \n Telephone : $telephone \n "; $from = "From: $email\r\n"; mail("secretary@leominstercivicsociety.co.uk", $subject, $message, $from); ?>

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