Quills Membership Application Form

 

Name

 

 

Address

 

 

 

 

 

Home Tel

 

Work Tel

 

Mobile Tel

 

Email

 

Website

 

Joining Date  

Birthday (dd/mm)

 

Company

 

Job Title/Description

 

 

 

 

Interests

 

 

 

 

 

 

How did you hear about Quills/reason for joining

 

 

 

Suggestions for speakers or events

 

 

 

Signed

 

 

 

Please attach a cheque made out to ‘Quills’ for £20 (annual membership fee) and send with this completed form to:

 

Caroline Dollings

Quills Treasurer

33 Stevenson Road

Ipswich

IP1 2EY