5 YEAR GOLD HOLDERS’ MEMBERSHIP APPLICATION/RENEWAL FORM

 

*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

 

 

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