Single Home Membership Application Form

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 box to indicate you would be happy to receive your newsletters by email. Obviously we would also need your email address. Thank You.

Home

Title

 

Name

*

Home Phone

Address

*

Email Address

 In What Type Of Property Do You Currently Live?

(e.g. Bricks &Mortar or Park Home)

Town

*

.

 

County

Are You In A Residents' Association?

Postal Code

*

I Would Be Happy To Receive 'The Advisor' By Email

STEP 2: Enter the date.

Today's Date

(DD/MM/YYYY)

* Required Fields

STEP 3: Print The Form

Please send this form to:

The Membership Administrator. (Individual Registrations)

IPHAS.

Ken Carroll
19 College Close
Probus, Truro
Cornwall
TR2 4LW

Please enclose cheque or money order made out to IPHAS for £ 6.00