BIMA 2018/2019 Membership Application Form

Name *
Name
Address *
Address
Phone
Phone
Membership *
Please check the appropriate box
This only needs to be filled in if want to have full membership
Confirmation of Gift Aid
Donor's Details
Donor's Details
Donor's Address
Donor's Address
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Privacy Policy (Data Processor)

Payment

To make payment via BACS:

NatWest Bank,
Northumberland,

Account No: 66636779
Sort Code: 60-15-28

Or make payment using this link