MEMBERSHIP FORM

 

PLEASE PRINT IN CAPITAL LETTERS

 

FULL NAME ----------------------------------------------------------------------------------------

 

RANK on board -------------------------------------------------

 

BRANCH ---------------------------------------------------------

 

COMMISION ---------------------------------------------------

 

FULL ADDRESS ----------------------------------------------------------------------------------

 

 

POST CODE -------------------------------------------

 

PHONE NUMBER inc code -----------------------------------------------------------------------

 

E.MAIL ADDRESS ---------------------------------------------------------------------------------

 

Return to HMS LLANDAFF ASSOCIATION

178 Sutcliffe House, Addison Way, Hayes, Middlesex, UB3 2DJ   0208 581 5693

Cheques payable to HMS Llandaff Association   Fee £3

 

Office use only.

 

Excepted     YES/ NO                         Membership Number Issued   (                   )

 

 

Date received