Membership Application Form

Postal Address: THE AUG, 40 Hythe Road, Methwold, THETFORD, Norfolk. IP26 4PS
UNITED KINGDOM

Telephone: +44 (0) 1366 728 152 Fax: +44 (0) 1366 728 871

Please PRINT the completed form before clicking on Submit as this will only advise us by email of your intended application. Then, simply SIGN the printed page to post with you subscription. We must receive a signed application with your subscription to enable us to hold your details on record.

*First name:

*Surname:

*House Name /No. & Street :

*Village/District:

*Town/City:

*County:

*Postcode:

*Country:

*Home Telephone:

Mobile:

Work Telephone:

Extent ion No. :

Fax:

*E-mail Address:

*Membership Type:

*Atelier Model :

*Your Dealer:

Once Completed, Please PRINT the page first to post with you subscription.

Clicking On Submit should open your email software and let you send your details to DTKM , we will then look out for your completed application in the incoming post.

Any Personal Message MessageMessage:

Address

Contact Details

Your Instrument

Name

*How long owned :

STANDING ORDER MANDATE

When PRINTED, please sign and date your application, thus giving us permission to keep all your above details on record as a member of the ATELIER Users Group.

Applicant’s Signature:

Dated:

NEW MEMBER DETAILS