---

Membership Application Form

---

Mr/Mrs/Ms/................................................ (First Name) .......................................................... (Surname)

Address ...................................................................................................................................

.................................................................................................................................................

.................................................................................................................................................

............................................................................... Postcode ..................................................

Tel. No....................................................................

Corporate Membership - give contact name .............................................................................

---

Annual Subscription Rates

Either (Single) Membership of CDA - Individual/Family £15

Or (Dual) Membership of CDA & BDA - Individual/Family £20

Corporate (e.g. schools, colleges) £25

For Dual Members only, BDA also requires:

Email address  .............................................................................

I agree that I am willing to receive electronic communication from BDA - the British Dyslexia Association
 

(signed)  .............................................................................

When you have completed this form, please send it, with your annual subscription (cheques payable to Croydon Dyslexia Association) to:

CDA Membership Secretary
c/o 2 Woodmere Close, Croydon, CR0 7PN.

This information is for the sole use of CDA's membership records and will not be passed on.

---

You can print this page or if you prefer download the the form in Word or as a PDF file:

• Use the Word Format
• Use the PDF Format

Back to Croydon Dyslexia Association Home Page