Application for Membership – Annual Fee
£12.50 or £10.00 unwaged – Renewable Sept annually
To pay by Bank transfer: SORT CODE 30-98-97 ACCOUNT No. 69902062
Please use your name for the Bank Ref when paying.

Please use the form below to apply for Membership of Bensham Grove Community Centre; please pay your Membership annual fee using the Bank transfer details shown above after you’ve submitted the form. We can then link up your Membership application with your payment.  Many thanks.

Please read the Member Charter before completing this form.

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Name *

First

Last

Address inc Postcode *

Telephone

should your &

Email *

Please tick if you do NOT wish to receive email newsletters

• I do not wish to receive email newsletters

Age *--- Select Choice ---18-2425-3940-6060+

Gender

• Male
• Female
• Rather not say

Ethnicity - how would you describe your ethnicity?

Medical Conditions Bensham Grove should be aware of i.e. asthma, heart conditions, etc

Emergency Name & Contact Number

Group(s) Attending, if any

Terms & Conditions *

• I Agree

I confirm I have read and understood the expectations of members on the Member Charter land will familiarise myself with the policies and procedures of Bensham Grove Community Centre which are available to view online.

The information above may be held by Bensham Grove Community Centre on computer and will comply with the Data Protection Act.

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