MEMBERSHIP APPLICATION FOR 2008

1 Middle Lodge, Plumtree Cross Lane, Barns Green, Horsham, RH13 0NL Tel: (01403) 733 623

The information supplied will be held on computer and treated as confidential. It is for office use only and will not be supplied to third parties. To help us keep our records up to date, please tick and complete below:

1.         MEMBERSHIP FEES

Surname & Title:         ______________________________________________

First Name:                 ______________________________________________

Address:                      ______________________________________________

____________________________ Code: ____________

Tel No:                         ________________(home)_____________________(work)

Fax No:                        ______________________________________________

Mobile No:                   ______________________________________________

Email Address:           ______________________________________________

2.         Are you able to help, or willing to assist or serve on our Committee or sub-committee?

Yes                              No

Please specify: _________________________________________________

3.         I am interested in the following areas of Ceramic Art:

4.

5.         I teach:            Adults                                      Children

      I conduct classes in the:

Morning                       Afternoon                     Evening

      These classes are conducted at: 

Studio Name:            ________________________________________

Address:                   ________________________________________

                                ________________________________________

Tel No/Fax:               ________________________________________

Email Address:          ________________________________________

Teaching for how many years? _______________________________

6.         I have been working with clay for:_____________________________

7.         I hold professional qualifications in Ceramic Art or the Fine Arts.

Please specify: ____________________________________________

                Privately taught by whom? _____________________________

                 I am/have been taught part-time at which institution and for how long? ______________________________________________

8.         Are visitors welcome at your studio?                        Yes                              No

                                                                                  By Appointment only

 9.         FORM OF PAYMENT

Cheque              Cash               Direct Debit              

Cheques must be made payable to Southern Ceramic Group

Account Details:           Southern Ceramic Group

Bank:                           Alliance & Leicester Commercial Bank Ltd.

Account Nr:                 179491504                 

Sort Code:                    72-00-00

IF YOU ARE PAYING BY DIRECT DEBIT PLEASE ATTACH A COPY OF THE DEPOSIT SLIP TO SCG. WE WILL NOT ACCEPT YOUR APPLICATION UNTIL CONFIRMATION OF PAYMENT IS RECEIVED.

SIGNATURE: _________________________________ DATE: ___________

THANK YOU FOR YOUR PARTICIPATION IN THE GROUP