APPLICATION FOR MEM BERSHIP
BLACK WOMAN’S HEALTH AND FAMILY SUPPORT

Membership No __________________ Ms/Miss/Mrs/Mr__________________
Fist Name _______________________ Last Name _______________________
Organization ____________________________________________________________
Address ________________________________________________________________
City ____________________________ Postal Code ____________________________
Country _________________________
Home Phone _____________________ Work Phone ________________________
Mobile __________________________ Email ____________________________
FEES- PAYMENT IN STERLING ONLY
EUROPE & REST OF THE WORLD ADD £ 5 FOR POST & PACKAGE
FUNDED ORGANISATIONS £10 SELF HELP GROUPS
WAGES INDIVIDUALS £5 UNWAGED INDIVIDUALS £1
J I/We support the aims of the Black Women’s Health And Family Support,
And hereby make Application for membership. Fee of £____________ is enclosed.
J I/We wish to also make a donation to the project in the amount of £_______
Make cheque payable to: Black Women’s health And Family Support
SIGNED________________________________ DATE _______________________
BWAHFS, 1 ST Floor, 82 Russia Lane, London, E2 9LU
Tel : 0208 980 3503 Fax 0208 980 631Email: info@bwhafs.co.uk
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