GRASA
Membership/Renewal
Name……………………………….......
Address………………………………....
………………………………................
………………………………................
Postcode…………….Phone
No……….
ACU Affiliation No……………………..
E mail…please tick to receive
newsletter by e mail ( )
………………………………..................
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
member)………..
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)