Headway Leicester

I wish to apply for membership of Leicestershire Leicester and Rutland Headway for the year 1 April 2005 to 31 March 2006.

I am

As well as making a valuable contribution to the Company, membership will entitle you to:
   (i) Vote at the Annual General Meeting
   (ii) Receive the quarterly newsletter and magazine at no further cost
   (iii) Be kept up to date on development activity
   (iv) Receive invitations to social events

I would like to pay my subscription (£10 for individuals, £50 for Companies) by (waived for those receiving direct services)
If you choose to pay by Standing Order you can print a form

I accept that in the unlikely event of the Leicestershire Leicester and Rutland Headway Ltd being wound up, I may be called upon to pay a sum not exceeding £10.00.

Contact details
Title: Name:
Address:

Telephone:
email:

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Email: | Phone: 0116 273 9763

	Membership Application
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Membership Application