Annual Membership Application - DD

Annual Membership Application - Direct Debit

Payment by Direct Debit
Single Membership £38Joint Membership £65
Name*

First NameLast Name
For Joint Membership - 2nd Name

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*

Area CodePhone Number
YesNo
YesNo
Thank you for your support
Once you click Submit, you will be directed to our secure Direct Debit Payment Page. Please enter your details.

You will receive an email confirming all has been set up.

Annual Membership is automatically renewed each year on 1st June.

We like to include all our member's names in our programme, please let us know if you prefer not to be included
Should be Empty: