British Association of the Alpes Maritimes & Var
Membership application
First Name:____________________ Sirname:___________________
Address:_________________________________________________
_________________________________________________
Telephone:__________________ Fax:_________________________
Mobile:_____________________ Email:________________________
Optional Information – delete what is not applicable.
Age group 25-45 / 45-65 / 65-75 / Over 75.
Are you a permanent resident (Yes / No)
Status – Retired / Working.
Car driver – Yes / No.
Would you like to;
1 Attend social functions (Yes / No)
2 Assist with social functions (Yes / No)
3 Visit people in hospital, in their home or retirement home (Yes / No)
4 Offer to drive someone (Yes / No)
5 Assist someone with shopping (Yes / No)
6 Offer any other assistance – if so, please outline below:
________________________________________________________
Your Signature:___________________________ Date:___________
Please return this section together with a cheque, payable to the British Association and send it to the Hon. Branch Secretary at the British Association Branch closest to you. (see the Contact Us Page)
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