MEMBERSHIP APPLICATION FORM
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 __________________________________
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

ST AUBIN - EMSWORTH TWINNING ASSOCIATION