Block Membership Application Form

(Min 5 Homes with distributor)

Fees are £5.00 per home. The distributor will receive a 10% discount based on the number of homes registered.

Please follow the numbered steps:

STEP 1: Complete the sections below.

IPHAS are keen to reduce paper waste. If you would like to assist us, please tick the boxes for all/any members happy to receive communications and notifications by email. Obviously we would also need those members' email addresses in order for us to be able to notify them accordingly. Thank You.

Home

Distributor Details

Park Details

Title

Park Name *

Name

* Address  *
Address on Park *
Home Phone Town *
E-mail Address County *
Are You In A Residents' Association? 

Postal Code *
I Am Happy To Receive All Communication By Email 

Member Details

Title Initial

Surname

Address on Park

Email Address

e-Comms

For more Member Fields please complete additional forms and enter total number of forms submitted here: *  

*Required Fields

STEP 2: Enter the date.

Today;s Date (DD/MM/YYYY)

STEP 3: Submit the form.

Please send this form to:

The Membership Administrator.

Rus Yates-Aylott
19 College Close
Probus, Truro
Cornwall
TR2 4LW

I enclose cheque or money order made out to IPHAS for