Membership Form

First Name:

Family Name (required):

Gender:
-- Please Select --MaleFemaleNon-binaryPrefer not to say

Date of Birth: (required)

Address Line 1:

Address Line 2:

Town / City:

Post Code:

Email (required):

Mobile number:

Membership Agreement

By applying for membership, you are confirming the following:

• I agree to uphold Ponthafren’s Values in all my dealings with or on behalf of Ponthafren.

• I agree to attend (physically or virtually) the Annual General Meeting.

I confirm that I agree to the above (required):
I confirm that I agree to the above.

How I Wish to Support Ponthafren

And I wish to support Ponthafren by (tick all that apply) (required):
volunteering some of my timefundraisingmaking a regular donationoffering support in some other way

On receipt of this information, we will be in touch by email to help you to volunteer, fund raise or make donations.