CHANNEL DASH ASSOCIATION

MEMBERSHIP APPLICATION FORM

Full Name:       ________________________________

Address:          ________________________________

                       ________________________________

                       ________________________________

Postcode:         ________________________________

Tel. Number:   ________________________________

Mob. Number:  ________________________________

email Address: ________________________________

 Annual Subscription:   7.50.

Cheque to be made payable to:      Channel Dash Association

           and sent to:      The Membership Secretary. 

                                  Channel Dash Association.

                                  189A, Ramsgate Road,

                                  Broadstairs,

                                  Kent. CT10 2EW

"I ask that my subscriptions and other donations be treated as Gift Aid. *I am a UK Taxpayer".

*(Please delete if you are a non-taxpayer)

Signed:                                  Dated: