GRASA

Membership/Renewal

Name……………………………….......

Address………………………………....

………………………………................

………………………………................

Postcode…………….Phone No……….

ACU Affiliation No……………………..

Rider £15.…………………………….....

Supporter /Official £8.…………………..

Rider/Spouse) £20.………………..........

Husband/Wife (supporter)£12.………….

Family(with (rider) £25.………………..

Family membership is for all NON riding children

Family (supporter) £15.………………….

Youth £5 must have adult as full mem)………..

Please return completed form with correct fee and SAE to:-
Mrs. D Wain
104 Purbrook Way,
Leigh Park,
Havant.
HANTS
PO9 3SB

Tel: 02392-644061

(Family membership includes all NON riding children under the age of 16
please include children’s birthdays on back of form)



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