GRASA
Membership / Renewal

Name........................................................................................
Address.....................................................................................
            .....................................................................................
            .....................................................................................
Postcode.........................................Phone No............................
ACU Affiliation No.....................................................................
Rider.......................Official...................Supporter......................
Rider: £12.00.............................................................................
Supporter/Official £8..................................................................
Husband/Wife (Rider) £18.00......................................................
Family (With Rider) £20.00.........................................................
Family (Supporter) £15.00..........................................................
Youth £5.00...............................(Must have adult as full member)

Please return completed form with correct fee and SAE to:-

Mrs. Di Wain
104 Purbrook Way,
Leigh Park,
Havant.
HANTS
PO9 3SB

Tel: 02392-644061