Membership Application Form

Please complete and submit the form below with applicable and relevant details, and a member of the Committee will contact you shortly.

How long have you lived in East Anglia?
Where did you first hear about EASAZ?
How long are you planning to live in East Anglia?
Full Name

Title

Age Birthday

Residential address

Address

Town

County

Postcode

eMail address

Marital status

Name of spouse/partner

Child/ren: name/s and age/s

Contact telephone numbers

Mobile

Home

To enable your Committee to arrange suitable activities in the future, please take the time just to check the activities that would be of interest to you below :

Paintball

Pub crawl

Family braai

10-pin bowling

Weekend camping

Bingo

Pub quiz

Boat trip

Fishing (saltwater)

Barn dance

Potjiekos competition

Raffle

"Bring 'n Share"
dinner party

London day trip

Hiking

Fishing (freshwater)

Other activites that would interest you?

Membership Application Form

Last revised :- 22 March, 2011