THE ASSOCIATION OF BLIND PIANO TUNERS
MEMBERSHIP APPLICATION FORM

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Name____________________________________

Date of birth_____________

Address________________________________________________________________

Town______________________
Post Code________________________
Telephone No.____________________
E-Mail Address:________________________________________

State name of establishment where you were trained_____________________
Qualifications______________________________________________________
Year in which Qualifications were attained_____________________________
State format of literature:
BRAILLE, PRINT or EMAIL(Delete as appropriate)

Type of membership________________________________________________

DETAILS OF MEMBERSHIP
MEMBERSIHP FEES
FULL MEMBERSHIP (£55.00)
ASSOCIATE MEMBERSHIP (with Diploma) (£55.00)
ASSOCIATE MEMBERSHIP (with Certificate) (£25.00)
OVERSEAS MEMBERSHIP (£25.00)
FRIEND OR SUPPORTER (£15) minimum donation
STUDENT MEMBERSHIP (free until completion of training)

Please include a pass port size photo of yourself

Signature of Applicant_______________________

I enclose my cheque/postal order For £______________ Date___________

All cheques should be made payable to the Association of Blind Piano Tuners or ABPT. When completed this form should be sent to:

Membership Liaison Officer:
Mr. S Workmann
2 St Davids Drive,
Killay, Swansea,
Wales SA2 7EN
Tel: 01792 208026


SC/BH/WEB