FOIRM BALLRACHD/MEMBERSHIP FORM

BALLRACHD CHULTARLANN INBHIR NIS

MEMBERSHIP OF CULTARLANN INBHIR NIS
FOIRM BALLRACHD/MEMBERSHIP FORM*

Ordinary MembershipFriends of Cultarlann (Associate Membership)
Ainm / Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email*
example@example.com
Organisation Name

TERMS OF THE MEMBERSHIP

I am aged 16 or over
I support the purposes of Cultarlann Inbhir Nis
I undertake to pay the membership fee/donation

I undertake to pay £1 if the company should wind up
I consent to my personal details being kept by the Company and understand that they will not pass them to any third party unless it seeks my specific permission or is required to provide details of membership under the Companies Act 2006.

Check the box below if you understand the above terms and give permission to Cultarlann Inbhir Nis to hold this information.*

Yes, I consent to the above.
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