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Membership Application Form Membership Type

Surname: Fore Name: Other Name: Telephone No: Email id: Date of Birth: Current Address:

Honorary Life Membership


Applicant Information

Ordinary Membership

Mobile No:

______________________________________________________________ ______________________________________________________________ _____________________________Postal Code ____________________

Spouse & Children Information if membership privileges desired Your Star Sign: Spouse Name: Star Sign: 1st Childs Name: Star Sign: 2nd Childs Name: Star Sign: 3rd Childs Name: Star Sign: 4th Childs Name: Star Sign:

CASH

Payment Method CHEQUE

STANDING ORDER

Click here to authorize the use of your email and address for future communications I do hereby declare that I will abide by the constitution of Sri Ayyappan Kovil (Lond0n); I understand that it is my responsibility to maintain the subscription.

Signature of Applicant:

Date:

Signature of Spouse, only if for a joint membership:

Date:

Office Use only


Received on: __/__/__ Mebership No Allocated ReceivedBy:________________ Authorised By:_________ Date __/__/__

__________________________________________________________________
WWW.LONDONAYYAPPAN.ORG Charity Reg. No: 1059478

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