NAPICU Ward Membership 2024

WARD Membership Application

To apply for membership please complete all questions.
Ward Name*
Ward Contact Number*
Mobile or Landline
Ward Address*

Street Address

Street Address Line 2

CityCounty

Post CodeCountry
Main Ward Contact Name*

PrefixFirst NameLast Name
Main Ward Contact Email*
example@example.com
Is the Main Ward Contact also the Ward Manager?*

YesNo
Ward Manager Contact Name

PrefixFirst NameLast Name
Ward Manager Email
example@example.com
Additional Ward Contact Name

PrefixFirst NameLast Name
Additional Ward Email
example@example.com
Membership Type*
prevnext( X )
1 Year Membership
£695.00



2 year Membership
£1,300.00



3 year Membership 2
£1,800.00



Total

£0.00
Billing Address Information
Trust/Organisation Name*
Billing Address*

Street Address

Street Address Line 2

CityCounty

Post Code
Billing Contact Email*
example@example.com
Purchase Order Number
Signature*

Clear
Print Name*
Once completed please return to the administration office – info@napicu.org.uk

NAPICU Administration Office
238 Main Street, Rutherglen, Glasgow, G73 2HP
T: 01355 244 585 E: info@napicu.org.uk
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WARD Membership Application