Homepage

Surname            Forename

Address

        Post Code

Age      Date of Birth         Gender

Ethnicity (culture and Identity eg. White Welsh)

Telephone   Mobile

Email address

AAW Member Yes/No  AAW Membership Number

Do you consent to your personal details being held on a club membership database? Yes/No

Are you happy for your contact details to be included in the monthly newsletter? Yes/No

Are you happy for any club photos including your image to be displayed on the club website?  Yes/No

EMERGENCY INFORMATION

Emergency Contact Name

Telephone number Mobile

Do you have any disability, illnesses or special needs? Yes/No (if yes please give details below)

Annual Membership is £15.00 (£7.50 if joining after 1st October)

OFFICE USE ONLY

DATE OF JOINING

DATE MEMBERSHIP PAID

DATE PAYMENT PASSED TO TREASURER

DETAILS PASSED TO NEWSLETTER EDITOR  Yes/No