Membership Application form (Printable Version)

Name:_________________________

Address: ______________________

______________________________

______________________________

Phone: _________________________

Mobile:________________________

Email:_________________________

Area where you may be able to give support /assistance

General admin. o

Grant application / Fund raising o

Publication of Newsletter o

Research o

Conference organisation o

Journal publication o

Talking to groups o

Working with other agencies o

Website management o

Other: _________________________

______________________________

I enclose £ 10.00 annual membership fee and a donation of £____________

Initial Annual Membership fee of £10 includes annual subscription of ICARUS Newsletter

Donations of over £100 per annum are acknowledged in ICARUS publications. Tick box if you want this acknowledgement.