*I WISH TO APPLY FOR 5YR GOLD HOLDER MEMBERSHIP/ RENEW MY MEMBERSHIP    

   ( delete as applicable) Please use block capitals and black ink to complete this

    form

5 YEAR GOLD HOLDERS’ MEMBERSHIP APPLICATION/RENEWAL FORM

Name .................................................................................. Title..............

Address ....................................................................................................

            ............................................................................Post Code...........

Telephone .........................................   email ...........................................

repeat email .........................................................................

If you know your 5 year mem. no. please include .................

Your details are stored electronically by The Discovery Award

I finished my Gold Discovery Award on .....................................

I was part of .............................................................................Group

Please do not/ send my mailings to my Group Leader* 

5 year Gold Membership Fee is £12.00 for which I understand I wil receive Newsletters, relevant mailings and an invitation to attend Annual Gatherings

for a further 5 years.

Please send your cheque for £12.00 made payable to

The Discovery Award with this form to: 

        The Discovery Award Membership

         74 Stevens Road   Stourbridge

         West Midlands   DY9  0XW

         admin@discoveryaward.org.uk