Application for Membership of Gestalt SouthWest

I wish to apply for Membership of Gestalt SouthWest. I enclose my cheque payable to Gestalt SouthWest.

£10

or

£15 to include formal notices by post

Name:
Address:
Telephone:
Fax:
Email:
Signed:
Date:

Tick if receipt required

Please compete this form, print it off and send it with your cheque to:

Gestalt SouthWest
c/o Alison Cameron
7 Junction Avenue
Oldfield Park
Bath
BA2 3NJ