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MEMBERSHIP APPLICATION FORM
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Surname _________________________________________
First name ________________________________________
Partner's first name _________________________________
Partner's surname (if different) _________________________
Children's first names and ages
____________________________ _____
____________________________ _____
____________________________ _____
____________________________ _____
Address _______________________________________________
_______________________________________________________
Postcode ________________________
Tel: _________________________ Email: _______________________
Do you wish to go on an exchange visit? Yes / No
... with your family? Yes / No If yes, how many in total? _______
How many visitors can you accommodate comfortably? ________
What level is your knowledge of French? (please circle)
Good / Needs practice / Little or none
Car driver? Yes / No
Annual subscription: single person £15; family £20.
Payment enclosed £______________
(please make cheques payable to St Aubin-Emsworth Twinning Association)
Signed __________________________________
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The Association welcomes applications from anyone resident in Emsworth and the
surrounding area but asks members who go on exchange visits to be equally welcoming to our French friends. Please complete and return this form to:
Hon. Treasurer, Mr M de Laporte, Lane Ends, 54 Hollybank Lane, Emsworth,
Hants. PO10 7UE |
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ST AUBIN - EMSWORTH TWINNING ASSOCIATION
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