ASNA Membership form
Please use this form to tell us about yourself and how ASNA can be of service to you. Please use one form per person.
Sign in to Google to save your progress. Learn more
Email *
Title *
Required
First Name *
Second Name *
Please repeat your most active email Address *
Postal Address *
Telephone (Mobile) *
Telephone (Land Line) *
Please tell us how ASNA can service you and / or your family or leadership. *
Required
Please tell us how you can be of service to ASNA *
Required
Do you have someone in your family living with a disability? *
If yes, please give details below *
Required
Please give as much details as possible so we can serve you well. Please list all the names and any disabilities of relatives in the family e.g Son - Name - Matthew, Age, 26, Disability - Blind with learning disabilities *
Thank you for your details  all of which will be used for ASNA purposes only. You can ask to see or have your details removed at any time. These details will be kept in a password protected format. Please indicate below receipt of this policy *
Please indicate below your consent to your image being stored or used for ASNA purposes (such as report writing, funding applications, promotion and marketing on ASNA social media platforms and website). *
Gift Aid Declaration: Boost your donation by 25p of Gift Aid for every £1 you donateGift Aid is reclaimed by the charity from the tax you pay for the current tax year. Your address is needed to identify you as a current UK taxpayer. I am a UK taxpayer and understand that if I pay less Income Tax and/or Capital Gains Tax in the current tax year than the amount of Gift Aid claimed on all my donations it is my responsibility to pay any difference. Please notify the charity if you: want to cancel this declaration change your name or home address no longer pay sufficient tax on your income and/or capital gainsIf you pay Income Tax at the higher or additional rate and want to receive the additional tax relief due to you, you must include all your Gift Aid donations on your Self-Assessment tax return or ask HM Revenue and Customs to adjust your tax code. *
Choose your payment plan for ASNA membership here https://www.asna.info/plans-pricing. Benefits include reductions to ASNA events and resources, welcome pack and regular updates. Please make payment direct into ASNA account. The account details are as follows. Account Name of Bank: Lloyds Bank Account Number: 03151450, Sort Code: 30 91 53. Please use your name as reference. Please indicate below anything we need to know regarding your payment. Please also sign your name in the space below *
Please give the date of completing this form. *
MM
/
DD
/
YYYY
To ensure we do not miss the payment for the membership, please send an email to info@asna.info as soon as payment has been made. Thank you. *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of ASNA. Report Abuse
Google Forms