Name ________________________________________________________________

Address  ____________________________________________________________

_____________________________________________________________________

Postcode  _________________ Date of Birth (optional) ________________

EVENING Telephone (including STD code) ______________________________
 
e-mail address ______________________________________________________

How did you find out about the Siân Project Group? 

_____________________________________________________________________

I apply for Associate Membership of the Siân Project Group and agree to abide by the group’s articles of association (available on request). I understand that the information supplied on this form will be stored electronically on a database/mailing list for administrative use within the Siân Project Group, and no other purpose.

Signed  _____________________________________________________________

Date  ________________

                                         1 year’s membership £ 10.00 

               Voluntary donation towards maintenance costs  £ _____

Please make cheques payable to “Siân Project Group”.  Total  £ _____

Please send your application to
Felicity Fuller,
SPG Associate Membership Secretary,
4 Grange Cottages, Marsden,
West Yorkshire. HD7 6AJ.

Associate Membership

Application Form