Amersham & District Residents Association
Application Form
Please print this form and post to
Hon Records Officer.
Mrs
Rosemary Dean
42 Hollybush Lane
Chesham Bois
Amersham
Bucks.
HP6
6EB
I / We wish to join the Amersham & District Residents
Association
The subscription for three years is £6 per household or
£4 where there is only one adult.
I / We enclose
£..........................................
Name(s)
...........................................................................................
Address
..............................................................................................
..............................................................................................................
................................................................................................................
I
/ We agree to the records of our membership being kept in computerised
form
Signed
........................................................... Date
____/____/____
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