PAW Membership PAW Membership Form Purbeck Art Weeks Festival I wish to apply for membership and agree to pay £10 annual membership. I understand that the membership year runs from 1 January to 31 December and that the membership fee of £10 is due on 1 January each year. I give my details below and confirm that I live or work or study in Purbeck.Your DetailsYour Name* First Last Your Address*Your Address must be in the Isle of Purbeck Street Address Address Line 2 City County Dorset Postcode Your Email* Enter Email Confirm Email Username*Please enter a username - in future you will be able to login with your username or email addressPassword*Please create a password for you to use to access your account and forms Enter Password Confirm Password Strength indicator Main Phone*Your main phone number, mobile or landlineSecond PhoneOptional second phone number, mobile or landlinePaymentPlease Enter Your Name*Please enter your name and tick the I Agree box below, to agree that you have paid or will pay the annul membershipTerms*I AgreePayment OptionsPlease select your payment option belowCard SubscriptionStanding OrderAnnual Subscription Price: £ 10.00 Credit Card Subscription* American ExpressDiscoverMasterCardVisa Card Number Expiration Date Month010203040506070809101112 Year20172018201920202021202220232024202520262027202820292030203120322033203420352036 Security Code Cardholder Name Billing Address*If you billing/card address is different from your home address, please enter it below, or click the "Use same as Home Address" tick box below. Street Address Address Line 2 City County AvonBedfordshireBerkshireBuckinghamshireCambridgeshireCheshireClevelandCornwallCumbriaDerbyshireDevonDorsetDurhamEast SussexEssexGloucestershireHampshireHerefordshireHertfordshireIsle of WightKentLancashireLeicestershireLincolnshireLondonMerseysideMiddlesexNorfolkNorthamptonshireNorthumberlandNorth HumbersideNorth YorkshireNottinghamshireOxfordshireRutlandShropshireSomersetSouth HumbersideSouth YorkshireStaffordshireSuffolkSurreyTyne and WearWarwickshireWest MidlandsWest SussexWest YorkshireWiltshireWorcestershireClwydDyfedGwentGwyneddMid GlamorganPowysSouth GlamorganWest GlamorganAberdeenshireAngusArgyllAyrshireBanffshireBerwickshireButeCaithnessClackmannanshireDumfriesshireDunbartonshireEast LothianFifeInverness-shireKincardineshireKinross-shireKirkcudbrightshireLanarkshireMidlothianMorayNairnshireOrkneyPeeblesshirePerthshireRenfrewshireRoss-shireRoxburghshireSelkirkshireShetlandStirlingshireSutherlandWest LothianWigtownshireAntrimArmaghDownFermanaghLondonderryTyrone Postcode Use same as Home Address? Yes, use Home Address It would be very helpful if you would arrange for your membership fee to be paid by Standing Order from your bank. After clicking Submit please download the Standing order form, fill in your details and pass to your bank. If you could also complete a Gift Aid Declaration, copy also attached to the Standing Order form, that would benefit our Charity.