YAMSEN:SpeciallyMusic Membership Form
Please print this page, complete the form and return the completed form with remittance to:

YAMSEN:SpeciallyMusic
The West Park Centre
Spen Lane
Leeds
LS16 5BE

Make cheques and postal orders payable to YAMSEN

If you wish to pay by standing order please tick here  [    ] and we shall send you the necessary form

• Membership runs from March to March
• Remittance may be by cheque, postal order or standing order; please do not send cash through the post.

Tick type of membership required

Corporate membership £25 per annum    [     ]
Individual membership £10 per annum    [     ]
Concessionary membership £5 per annum [     ]

I would like to receive information about :
All activities [    ]    Activities for children [    ]    Activities for adult groups [    ]

Name of individual or organisation's representative

First name_________________ Surname _________________________

Name of organisation__________________________________________

Address____________________________________________________

__________________________________________________________

Post Code___________________Tel.No__________________________

Email______________________________________________________

I enclose remittance of _______________Date______________________

Signed _____________________________________________________