*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