I, ..........................................................................................................[please print full name of applicant]

of ....................................................................................................................................[postal address]

........................................................................................................................................[email address]

............................................................[telephone]

hereby apply to become a member of the above named incorporated association. In the event of my admission as a member,

I agree to be bound by the constitution of the Society for the time being in force. I will advise the Society if my details change.

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Signature of applicant                                                                                                             Date
 

Lacemaker Family……………………………………………………………………   Ship (if known)…………………………………………………………………