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PURLEY AND DISTRICT TOWNSWOMEN’S GUILD

APPLICATION FOR MEMBERSHIP OF PURLEY AND DISTRICT AFTERNOON TOWNSWOMEN'S GUILD*



NAME ………………………………………………………………… (MS/MISS/MRS etc) ……………………


ADDRESS*


………………………………………………………………………………………………………………………………………


………………………………………………………………………………………………………………………………………


POST CODE ………………………………………………   DATE OF BIRTH …………………………………………


LANDLINE ……………………………………………  MOBILE…………………………………………………………………


EMAIL ……………………………………………………………………………………………………………………………………





SIGNATURE …………………………………………………………………  DATE ……………………………………………


GIFT AID YES/NO


PLEASE HAND THIS FORM TO THE TREASURER  TO ENSURE YOU GET YOUR MEMBER BENEFITS ASAP.



ADMINISTRATION   


MEMBERSHIP NUMBER ……………………………………………………………………


* May also be used for change of address.


AMOUNT PAID £………………………………………  FULL / PRO RATA


CONTACT DETAILS CHECKED YES/NO  GIFT AID YES/NO