Membership

Membership Application Form

Association of Senior Muslim Citizens (ASMC) — Registered Charity No. 1112317

Title

If Other, please specify

Surname

First Name(s)

Home Address

Telephone Number

Mobile Number

Email Address

Date of Birth

Languages you speak, interests and hobbies

Activities you like / should be introduced to by ASMC

Do you require social contact by phone or visit? Please explain briefly

Membership Type

Single Membership — £10 per year Couple Membership — £15 per year Life Membership — £80 one-off (age 60+)

Payment Information

Membership fee is payable annually from 1st January. You can pay online via bank transfer or arrange payment directly with the committee.

Note: Couples should each submit a separate form. Life membership is available to members aged 60 and over for a one-off fee.

Account Name ASMC

Bank Lloyds Bank

Sort Code 30-93-92

Account Number 03088381

Payment Reference: Please use your Surname and Postcode.

I hereby apply for membership of the Association of Senior Muslim Citizens (ASMC) and accept its aims and objectives. I agree to abide by its rules and regulations as set out in its constitution...

I confirm that I am a Muslim.

I agree to my details being kept on the ASMC database..

Type your full name to sign

Membership Application Form

Payment Information

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