Membership Form
Please complete in BLOCK CAPITALS

Title: - Mr., Mrs., Miss, Ms., Dr., (or Other ………….) please circle as appropriate.

Surname ……………………………………… First Name …………………………………..

Address ………………………………………..............................................................

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Post Code..........................................

Telephone ……………………………...........Fax……………………

Email …………………………………...

Membership Category:…………………. Paid: £…………………….

Proposed Annual Subscription:

Full Member ………………………£5.00
Family Member (2 adults)………….£7.50
Junior Member (under 18)…………. £2.50

Payable to "St Philips & St James (LeckhamptonArea) Residents Association"
and return to Ian Wilkinson, 47 Gratton Road, Cheltenham GL50 2BZ

* Please indicate if you would be interested in becoming a member of the Committee


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ST PHILIP & ST JAMES (LECKHAMPTON) AREA RESIDENTS' ASSOCIATION

Receipt

Received the sum of £ …………………..

Date: ……………………………………

Signed: ……………………………..................................(Treasurer)