Membership Form

Membership Application / Renewal Form

Addlestone Community Association
Addlestone Community Centre

Garfield road,

Addlestone,

Surrey KT15 2NJ

01932 843646

Charity Registration Number 304962
Membership Year 1st April to 31st March

Fees:

Single adult applications: £3.50 per annum

Single Life Membership: £35 (over 65s £17.50)

Couples (same address) joint applications: £5.50 per annum

Couples Life Membership: £55 (over 65s £27.50)

Juniors (under 18) £1 per annum

This form is join the ACA and not for Section Membership.
Name*

First NameLast Name
If you are already a member of a Section, please indicate which one - otherwise, type NONE*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Date*

DayMonthYear
Date
Affiliated Local Organisations

This is available using this form and costs £7 per annum.

The ACA collects and stores limited information to process your application and manage your membership. To view our data policy, please visit our website.
For office use only

YearMembership Number
New / Renewal
Should be Empty:

Membership Application / Renewal Form