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Name
D.O.B
Address
(including Postcode)
.
Telephone
Number
Email
Address
Adult Society Membership £80.00
Adult Disabled Membership £40.00
Adult Concession Membership (over 65) £40.00
Junior Society Membership £40.00
Junior Disabled Membership £20.00
Please tick appropriate box
New Adult Membership Joining Fee £10 00 (to be added to above fees)
New junior Membership Joining Fee £5 00 (to be added to above fees)
Total Amount Enclosed
£
.. Cheques to be made Payable to NICAS
Completed application along with appropriate fee and 2 Passport size photographs to be sent to;-
Gary Webb.
The Chairman,
2 Balmoral Dale,
Bangor,
Co. Down,
BT19 7XJ