Please complete ALL fields
Circle Name
Circle Number
Area
Details of person submitting this form:
First Name
Surname
Email Address
Current Post
Please Select...
Chairman
Vice Chairman
IPC
Secretary
Treasurer
Membership
Charities
Member
Details of New Member:
Title
Please Select...
Mrs
Miss
Ms
Dr
First Name
Surname
Address
Town
Post Code
Home Telephone
Mobile Telephone
eMail Address
Date of Birth
Day
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Month
January
February
March
April
May
June
July
August
September
October
November
December
Year
1963
1964
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1970
1971
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1977
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1981
1982
1983
1984
1985
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1988
1989
1990
Date to be inducted
Day
01
02
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31
Month
January
February
March
April
May
June
July
August
September
October
November
December
Year
2008
2009
2010
Occupation
Are you prepared to be contacted to give professional advice to the National Exec?
YES
NO
Please tell us how you heard about Ladies Circle
Please Select...
Special Event
Personal Introduction
Leaflet
Press
Internet
Other
If "Other", please specify
Personally introduced by
Do you require a New Member Pack with Badge?
YES
NO
Comments
DATA PROTECTION ACT
The information given on this form will be held on NALC’s database whilst the individual concerned is a full member of the Association. This information will be used by the Association for the purposes of membership administration and enquiries, for producing statistical information for marketing purposes and for production of the NALC directory.