Shincliffe Community Association

Application for Membership 2005

Surname:___________________________


Forename(s):________________________


Address:___________________________

__________________________________

__________________________________


Telephone: _________________________

Please indicate age range:

Under 18

18 to 49

50 or over

I agree to abide by the rules of the Association

Signature: _____________________________________

Fees

Under 18s (with date of birth provided): 60p
Adults: £1.25

Print