Application for Membership – Chippenham Twinning Association

Fields marked with * are required

Title *

First Name *

Family Name *

Address *

Please enter your full address and postcode in the box above.

Your Email *

Contact Tel. No. *

Please enter your preferred contact telephone no.

I am applying for the following membership(s). Please tick one or more of the boxes below.

Family - £36 a year
Individual - £18 a year
Senior (over 60yrs) - £15 a year
Junior (under 18 and not covered by family membership) -£15 a year
Corporate - £36 a year

Family member names

For Family Memberships or joint memberships, please list above, all names of those to be included in the membership and indicate it they are adult (over18) or children (under 18).

Please select the payment type you will be using and then enter the amount in £s in the box below.

One time BACS Transfer
Standing Order
Cheque

Amount sent by BACs, Standing Order or Cheque *

Please enter the amount you have remitted by your chosen method.

APPLY ONLINE NOW - Fill in the form below and submit using the button at the bottom