MEMBERSHIP FORM 2012

Membership starts from 1st January to 31st December

NAME                   ………………………………………..

TRADING AS       ……………………………………….. 

DATE STARTED ……………….....................................

ADDRESS           ………………………………………........................................................................................................................

POSTCODE          ………………………………………..

CONTACT DETAILS:

TELEPHONE
BUSINESS            ………………………………………..  HOME ……………………………...

FAX                         …………………………………….  MOBILE …………………………….

E-MAIL                   ……………………………………   WEB SITE ………………………….

FULL MEMBER £24.00 ………………………          STUDENT MEMBER £5 ………….
(Please enclose copy of student card and details of course attending)

Please make cheques payable to:  Crafts from Carmarthenshire

FULL DESCRIPTION OF YOUR CRAFT   [PLEASE PROVIDE SAMPLES OF YOUR WORK]

• □     please confirm that you have your own Public Liability Insurance 
• □     please confirm that you have read the constitution

SIGNATURE         …………………………………… DATE         …………………………………….

Please return this form to
The Membership Secretary, Crafts from Carmarthenshire
Haulfan Caerbryn Road
Penygroes
Llanelli
Carmarthenshire
SA14 7PH
07854 798032
01269 845725

• □ Data Protection Act – Your details will only be used within Crafts from Carmarthenshire
• (Please tick)
• □ Crafts from Carmarthenshire will not pass any details about me to a third party without prior permission
• (Please tick)