Registered Charity No. 288939
Ipswich Arts Association - Membership Application Form
Please complete this form and return to:
Mary Odam, IAA Secretary,
38 Forest Lane, Martlesham Heath, Suffolk IP5 3ST
Group / Society Name: ……………………………………………………………………...
Meeting Place and Day: ……………………………………………………………………..
Number of members:………………
Area of Interest: Please circle, Crafts / Dance / Drama / Film & Media / Music /
/ Literature / Photography / Visual Arts / Community & Education /
Membership category / Annual subscription rate:
Large group - (80 members and over) £50.00
Small group - (79 members and under) £25.00
Group/Society website:……………………………………………………………...... …
1.Chair name: ......
Chair address (inc postcode) ……………………………………………………………….…...
……………………………………………………………………………………….……….…
Chair telephone ……………………………………………………………………......
email ......
2.Secretary name: ......
Secretary address (inc postcode) ………………………………………………………………
………………………………………………………………………………………………......
Secretary telephone ......
email …………………………………………………………………….…......
Contd/
3.Treasurer name: ......
Treasurer address (inc. postcode) .………………………………………………………….…....
……………………………………………………………………………………………..….…
Treasurer telephone ......
email …………………………………………………………...... …….….
4. Please circle below, which of the above, (chair, secretary or treasurer) you wish to act as the main
IAA contact and to whom allIAA correspondence should be sent. If a different contact /address is
to be used, please circle option 4. Other - and supply details.
1. Chair 2. Secretary 3. Treasurer 4. Other (details below)
Name: ………………………………………………………………………...………………….
Address (inc. postcode) ……………………………………………………………………………..
……………………………………………………………………………………………………
.
Telephone ......
email …………………………………….……………………………...... ……….……
5. Please circle which of the supplied contact details you wish to appear on the IAA website.
These details will feature on the Member Organisations page and will be the public point of
contact for your group/society.
1. Chair 2. Secretary 3. Treasurer 4. Other
6. Along with your postal application, please send a short profile of your group/society and a representative photograph and or logo. This information will be included in your entry on the IAA website. Profile details and images may be emailed to:
For IAA use:
Date received: ...... Date accepted: ......
Signed: ......