Author: Frank
Last saved by: Graham Boyle
Company: Microsoft Corporation

Dunbartonshire Wind Ensemble Trust
MEMBERSHIP FORM 2007/2008

Applicant Information
Name: | Date of Birth (if under 18):
Address:
Town: | Postcode:
Home Phone: | Mobile Phone:
Email:
Musical Instrument Information
Main Instrument: | Grade:
2^nd Instrument: | Grade:
1^st RElative Information if Family  membership
Name: | Date of Birth (if under 18):
Main Instrument: | Grade:
2^nd Instrument: | Grade:
2nd RElative Information if Family  membership
Name: | Date of Birth (if under 18):
Main Instrument: | Grade:
2^nd Instrument: | Grade:
Emergency Contact
Name
Relationship:
Address:
Town: | Postcode:
Phone: | Mobile Phone:

Membership Fees
 (Cheque payable to Dunbartonshire Wind Ensemble trust)
Cheques can be handed in at Band Practice or posted to Sheila Rodger, 45 Manse Road, Bearsden, G61 3PN

Single Member Full fees | £80 | Date Paid:
Single Member Installment 1 | £40 | Date Paid:
Single Member Installment 2 | £40 | Date Paid:
Family Membership | £110 | Date Paid
Family Membership Installment 1 | £55 | Date Paid:
Family Membership Installment 2 | £55 | Date Paid:

If you are a UK tax payer DWE can benefit from GIFT AID on your subscriptions if you tick the box.     I am a UK tax payer  □

From time to time DWE takes photographs of the band for use in publicity please tick the box if you agree to photographs being used in this way.	
Please cross out as appropriate 
I agree/do not agree to photographs of my son/daughter being used for publicity for the band   
  _________________(signed)