MEMBERSHIP APPLICATION FORM

PLEASE USE CAPITALS

NAME   _________________________________TELEPHONE______________

FULL ADDRESS  ___________________________________________________                                ___________________________________________________                                ___________________________________________________

INDIVIDUAL MEMBERSHIP FEE   £10.00 PER HOME  (ANNUAL RENEWAL) I ENCLOSE CHEQUE FOR £________ Signed_____________________________Date_____________  

Personal details are for registration purposes only and are strictly confidential 

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BLOCK MEMBERSHIP OF RESIDENTS ASSOCIATIONS THROUGH AN ORGANISER £8.00 per home

FULL ADDRESS     __________________________________________________                                      __________________________________________________                                   __________________________________________________ 

SIGNATURE  ___________________________ DATE ______________________


PLEASE ENTER RESIDENTS NAMES & HOME NUMBER OVER LEAF

Return membership application form and subscription to.

Mr.  Malcolm Samways. 3. Silver Poplars, Kingswood, Albrighton. Wolverhampton, South Stakks.  WV7 3AP.

Tel.  01902  374987.

PLEASE MAKE CHEQUES PAYABLE TO PHRAA.