PAG Membership Form

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MEMBERSHIP APPLICATION

 


 


Name……………………………………………………………………………..

Address………………………………………………………………………..…

…………………………………………………………………………………..….

Post Code……….……….. Telephone ……………………..

Facsimile………….……… Mobile…………………………...

e-mail……………………………..………………………………..

I apply for FULL / SOCIAL / ASSOCIATE / JUNIOR* Membership

*Delete as appropriate

I enclose the Membership Fee / Donation of £ ……..

(see here)

 

Signed ………………………….………………………….. Date …../…../………

 

Please send completed applications to:

Treasurer, Positive Action Group,
Balladane, 7 Castle Mona Avenue, Douglas, IM2 4EA