PaCDDA

Peterborough and Cambridgeshire District Dyslexia Association

MEMBERSHIP APPLICATION FORM:

I/We wish to become a member of Peterborough and Cambridgeshire District Dyslexia Association and enclose a cheque for £15 Individual/Family Membership or£20for Corporate Membership& Listed Tutors.

Name (Mr/Mrs/Miss/Ms)______

Address:

Post Code:

Tel No (home/work):

Mobile No:email:

Helping out:I/We would like to support the Peterborough and Cambridgeshire District Dyslexia Association and am interested in (no commitment and don’t need to decide at this point) : -

Being a Member  Being a Volunteer  Joining the Committee/Sub Group 

Administration  Fundraising  PR/Communications/Marketing/Promotion 

Editing/writingnewsletter, website, reports, policy and strategies, representations etc 

Counsellor/Befriender  Helpline/Advisory Role 

Specialist Tutor/Teachers Assistant willing to assist with workshops/After school clubs 

Joining an ADULT SUPPORT GROUP  / a PARENT SUPPORT GROUP 

Other Please advise …………………………………………………………………………………………………………………………

Please also advise if you have any particular skills to offer ……………………………………………………………

Making a donation of £______…………………………………………………………..

Where did you learn about PaCDDA? Advertisement Website Word of mouth 

Exhibition/Event  Training Programme  BDA/other dyslexia association  Email 

Other  (Please specify) ………………………………………………………………………………………………………

Data Protection

The information you provide on this form will be entered on the PaCDDA’s database and used to process your membership. Please sign and date the box below to indicate your consent for us to hold your personal information. Your data will not be sold or shared with anyone else except the BDA.

Dual PaCDDA / BDA membership

I give my permission for my details to be passed to the British Dyslexia Association to sign me up as an Individual Member of that organisation, making me a dual PaCDDA/BDA member. You will receive BDA Contact magazines 3 times a year and reduced rates for their events.

Please return this completed form, membership fee & and any comments to:-

Membership secretary: Fay Dutton, PaCDDA, c/o 20 Chishill Road, Heydon, Herts, SG8 8PW

or bring it along to an event.

Cheques should be made payable to PaCDDA (or Peterborough and Cambridgeshire District Dyslexia Association, if you want to write it out in full!)

or contact us at (the email address will be changing soon but will still get through to us from this address). We hope to set up paypal soon so that you can pay on-line

For Office use only:

Membership fee paid

Amount: £………………………………Cash Y/N /cheque Y/N

Date paid: ……………/………/…………

Registered Charity No. 289009 (Form Version May 2013)

A voluntary organisation affiliated to The British Dyslexia Association (BDA)

HELPING THOSE WITH SPECIFIC LEARNING DIFFICULTIES