Asian Association Chesterfield & North Derbyshire

MEMBERSHIP FORM 2025

First name

Last name

Phone

Date of Birth

วัน

เดือน

ปี

Multi-line address

ประเทศ/ภูมิภาค

ที่อยู่

เมือง/อำเภอ

รหัสไปรษณีย์

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

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