Membership Form

Iremongers Pond Association

www.iremongerspond.org.uk

Tel: 0115 846 2993

 

NEW MEMBERSHIP APPLICATION

 

Please complete in Capital Letters:

Name: ………………………………………………..................................

Address: ………………………………………………...............................

…………………………………………………………………………….

…………………………………………………………………………….…………………………………………………………………………….

Post Code: …………… Contact phone No: ………………………….

Email: ..........................................................................................................

 

 

New member’s subscriptions for 2015 / 2016 are:

£26.00 – Full Member

£13.00 – Associate, OAP, Disabled & Junior Member (Under 16 on 1st May)

 

(All Memberships run from 1st May till 31st April)

For Junior Members, a parent or guardian must complete the box below.

 

Childs Date of Birth: ………………….

I agree to take full responsibility for the behaviour of the applicant.

 

Signed…………………………..................... (Parent/Guardian) Date……………......

 

 

 

 

 

 

 

Please send completed form ticking appropriate boxes by post with:

Cheque or Postal Order (Not cash) for appropriate amount made payable to:

IREMONGERS POND ASSOCIATION

 

Please include the following:

  • A stamped self- addressed envelope.

  • Two (2) recent passport sized photographs.

Please allow two weeks for your membership card to reach you.

 

Please post to:

Mrs Belinda Coxon

c/o. IREMONGERS POND ASSOCIATION

22 Eton Road

West Bridgford

Nottingham

NG2 7AR

 

The association reserves the right to refuse membership. In the event, money and envelope would be returned.