Membership Application Form

Early Dance Circle

Registered Charity No. 1097746

 Membership Application Form

To: Barbara Segal (Membership Secretary)

3 Thornhill Square
Islington
London, N1 1BQ
UK

Name: ………………………………………………

Address: ………………………………………………

………………………………………………

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……………… Post Code ………………

Tel. no. ………………………………………………

Email: Please print below.

                                       

Type of membership required (please tick)

Standard £20.00
Concessionary (for those on low incomes) £12.50
Couple £30.00
Group (up to 8) £80.00
Additional members (beyond the original ten) can be added at £10.00 each

Groups or classes you belong to (optional):
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Payment Options:

Membership is renewed annually. You may pay by cheque, or complete a standing order form (which will allow your membership to renew automatically each year, unless the membership fee changes). You may, if you prefer, send a cheque for your first year’s membership, and complete the form for future renewals.

Please select one (or both) of the following options:

  1. I enclose a cheque for £……………… (made payable to – Early Dance Circle)
  2. I enclose the Standing Order form ………………Yes/No

Foreign payments should be made in £ sterling, free of all charges to the recipient, e.g. by Post Office Giro, International Money Order or Bankers’ Draft.

Form Submission:

Please Print the form above and return to:
Barbara Segal, 3 Thornhill Square, Islington, London N1 1BQ, UK.

Click here for print friendly version

GIFT AID
Please sign here if you wish us to reclaim tax on your subscription plus any subscriptions paid after Setpember 2012.
NB – this applies only to those paying UK tax at the standard rate or higher.

Signature:………………………………………


Date:………………………………………