Membership Form

Our membership fee allows you to:

Take part in some activities for free as part of your membership
Additional classes available at greatly subsidised prices
Use of the Westway Centre
Subsidised lunches, hairdressing, podiatry facilities, ear clinic
Subsidised events as per our programme

Thank you for your response. ✨

Type of membership required(required)

Annual Membership £70 Half Yearly Membership £40

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

Payable to: The Westway
Account Number: 00941532
Sort Code: 30-91-72

Please use the member name as a reference.

Title

First Name

Surname

House Number

Street Name

Town

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

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.

Confirm Name

Today’s date (YYYY-MM-DD)

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

← Back