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Membership Form
Name:
Address:
Postcode:
Telephone:
Textphone:
Fax:
Mobile:
Email:
Occupation:
MEMBERSHIP CATEGORIES
FULL: This is open to those who have a lipspeaking qualification.
ASSOCIATE: This is open to those with an interest in lipspeaking and who subscribe to the aims and objectives of the Association.
MEMBERSHIP FEES ARE DUE ANNUALLY ON 1 JANUARY.
Please tick:
Full Member: £40.00  | Associate Member: £15.00  |
Membership renewal:  | New Member:  |
IF APPLYING FOR FULL MEMBERSHIP, PLEASE ATTACH A COPY OF YOUR LIPSPEAKING CERTIFICATE
Tick here if you need a receipt (please enclose an SAE): 
HOW TO PAY:
By cheque: 
Please make your cheque payable to Association of Lipspeakers and send it with this form to the membership secretary at the address below.
By standing order: 
If you wish to pay by standing order, please complete this form and return it to the membership secretary who will send you a standing order mandate.
Mrs Beverley Roberts,
Davenport Farm,
Squires Lane,
Tyldesley,
Manchester,
M29 8JF
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