Membership Application Form

Contact information (will only be used for purposes connected with Haringey Families):

Email
First name
*
Surname
*
Telephone
Mobile
Address
*
Town/County
*
Postcode
*
* required

Subscription:

One year£14.00
Two years£26.00
Three years£36.00
One year (Concessionary rate*)£7.00
* Documentary evidence may be required

Please sign:
Date:

If you are paying by cheque in a name different from the one you are using above, please provide the name of the account holder.

The completed form, together with your cheque or postal order made payable to Haringey Families, should be returned to

Membership Secretary
Haringey Families
84 South View Road
LONDON
N8 7LS

Thank you!