Membership Application Form

 

 

If you would like to join us, please print and complete this form and return it to our Membership Secretary:

Mrs Margaret Trasler

310 Outward Common Road, Billericay

CM11 2LT

 

 

Name:

___________________________________________________________________________________

 

Address:

_______________________________________________________________________________________

 

__________________________________________________________________________________________________

 

Post Code: __________________________________

 

Telephone: __________________________________

 

E-mail: _____________________________________

 

Please tick the appropriate box below

 

£3.00 Individual Membership 

 

£5.00 Family membership     

 

Cheques should be made payable to Billericay Twinning Association.

 

I/We would like to join the Association and hereby agree to the above details being held on a computerised membership database for use solely for Billericay Twinning Association affairs.

 

Signature __________________________________________________________________

 

Date: ____________________