Application form
Title (Mr, Mrs etc.) ............................................................. First name .............................................................. Surname .............................................................. Address .............................................................. .............................................................. .............................................................. E-mail address ................................................................. Telephone: day ............................. evening ...................... Type of membership (please tick) Single ...... Single Concession (Senior or retired) ............. Joint ....... Joint Concession (Senior or retired)......... Junior (under 18. Please state age ............. Full-time student ........................ Qualifications (not essential) ................................................... Other musical interests ............................................................ Present appointment as organist if any ...................................... Would you like your name to be added to the locum list? Sundays/ Weekdays/Area ........................................... ................................................................................... ................................................................................... Your quarterly copy of our newsletter, Sequencer, will be delivered by e-mail if you have provided an address. If you require a printed copy please tick .............. Signature ................................................. Date ...........................
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Please print and send to
Mr Alan Owen
11 Crossley Street
Sherwood
Nottingham NG5 2LF