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Asian Association Chesterfield & North Derbyshire

MEMBERSHIP FORM 2025

*First name

*Last name

*Phone

*Date of Birth

Month

Day

Year

Multi-line address

*Country/Region

*Address

*City

*Zip / Postal code

Email

*Membership Plan

*Name of Family Members included in this membership and their relation to main applicant

*Are you happy for your photo to be taken and used on our social media platforms / website/ print publications

Yes

No

BACS Details

NATWEST BANK PLC

NAME OF ACCOUNT HOLDER : ASIAN ASSOCIATION CHESTERFIELD

SORT CODE : 60-04-09

ACCOUNT NUMBER : 71432205

*Payment Made

Yes

No

Please call 01246 297452 and book your free cooking class

Penmore Business Centre, Unit 3, Saxton Close, Hasland, S41 0SJ

01246 297452

info@asianassociationchesterfield.org

©2022 by AsianAssociationChesterfield.

Registered Charity: 1183943

Tuesday, Wednesday, Thursday: 9.15am - 5pm

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