Membership Form

Our membership fee allows you to:

Take part in activities for free or with a subsidy
Visit and view the work of the Westway Charity
Receive subsidised services

Thank you for your response. ✨

Type of membership required(required)

Annual Membership £60 Half Yearly Membership £35

Membership is payable by popping into the centre or by bank transfer using the details below.

Payable to: The Westway
Account Number: 009415532
Sort Code: 309172

Please use the member name as a reference.

Title

First Name

Surname

Street Address

Apartment, suite, etc

City

Postcode

Date of birth (DD/MM/YYYY)

Mobile Telephone Number

Home Telephone Number:

Health Conditions

Allergies

Name and relationship of emergency contact

Emergency contact telephone number

Confirm Name

Today’s date (YYYY-MM-DD)

Please confirm your payment method(required)

Pay by Bank Transfer Visit the centre to pay at reception

I accept that, if I am accepted for the membership my details will be held on a secure database and will not be passed to any third party.

I am happy for the Westway to use my photograph in any advertising for publicity for the Westway.

Gift Aid

I am a UK taxpayer and would like The Westway Charity (Charity No 1188850) to reclaim the tax on all qualifying donations I have made, as well as any further donations, until I notify them otherwise. (required)

Yes No

Confirm Name

Date (YYYY-MM-DD)

Office Only

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