Membership Form

The information you give us is strictly confidential and will not be passed on to other third party.

Title: (Mr/Mrs/Miss/other )
Name:
Surname:
Maiden Name:	If applicable
Address 1:
Address 2:
Area eg. Archway or Holloway or Islington
Town / City eg. London, Southampton, Manchester
Post Code:
Date of Birth:
Tel No:
Mobile No:
Fax No:
Email:
Occupation	If retired occupation before retirement
Home Town/Village in Malta
How long in the UK?	Or Year of Arrival
What is your connection with Malta:	First Generation Maltese
	Second Generation Maltese
	Third Generation Maltese
	Spouse Maltese
	Associated/Friends with Maltese?
	Other



MEMBERSHIP FEE: FOR THE FIRST YEAR IS FREE
Donations to help towards the running costs of the organisation may be sent to: Membership Secretary Maltese Culture Movement P.O. Box 2964 London N19 4NS Tel: 020 7272 9000 Please make all Cheques/P.O payable to ‘MALTESE CULTURE MOVEMENT’

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