Membership

Membership Form
After filling the details click on the SUBMIT button.

*indicates required fields

*Title:

*Surname:

*First Name:

*House No. / Name:

*Address:

*Post code:

Telephone Home:

Mobile:

Date of Birth:

Annual Membership:

Do you Require Transportation:

Yes * £3 fee per day
No

Donation to Support Dostiyo *optional:

Total Paid:

Receipt No.:

Emergency Contact Numbers:

*Do you have known Medical or Mobility Problems:

Yes
No

Please give as much detail as possible:

Languages Spoken:

Gujarati
Punjabi
Urdu
Hindi
Bengali
English

Other please State:

Interested in Classes:

Exercise
Swimming
Computers
Art & Craft
English
Yoga
Sewing
Cooking
Lunch Club

Registered charity number 1058077
62-66 Dunster Street, Northampton NN1 3JY
Telephone 01604 745340 Fax 01604 745341
Email info@dostiyo.org.uk

Home | About Us | Annual Report | Activites | Membership