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North East Humanists Membership
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Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Choose Your Membership Option
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Unwaged / Retired / Student £6
Single Membership £10
Joint Unwaged / Retired / Student £11
Joint Membership (1 year) £15
How do you intend to pay for your membership?
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Using PayPal or your credit or debit card. Please follow the link at the end of the form.
Bank Transfer (one time)
Bank Transfer (standing order)
Cheque
Other (describe in final comments)
Can we claim Gift Aid on your behalf?
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Yes
No
Can we share your contact details within the group?
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Yes
No
Are you joining for the first time or renewing your membership?
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Joining
Renewing
Joint Member's Name (if applicable)
Your answer
Phone Number
Your answer
Street Address
*
Your answer
City
*
Your answer
Post Code
*
Your answer
(Optional) Can we add you to our "Young Humanists" list? We try to offer a few extra events for these members who are between the ages of 18 and 35.
Yes
No
(Optional) For purposes of monitoring diversity, could you please tell us your gender?
Your answer
(Optional) For purposes of monitoring diversity, could you please tell us your ethnicity?
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Additional comments or requests about your membership?
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Additional donation - £
If you would like to make an additional donation to our work you can do so here. Please write in the amount without the pound sign thank you.
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A copy of your responses will be emailed to the address you provided.
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