The Cheshire Dyslexia Association

Application for Membership


We are pleased to have an active Association in which all our members feel able to participate - we rely on your help and donations in order to continue our valuable work and finance the upkeep of our resource centre. Our subscription is £20 per annum for an individual or school, but your donations will also be gratefully received. It would help us if you could give the following information as you apply for membership.
 
Date of application
Name(Mr/Mrs/Miss/Ms)
Address



Telephone Number
E-mail Address
What is your particular interest? (Parent/Teacher/Student etc.)

Parents

Name of child
Date of birth
School
Has your child been assessed by an Educational Psychologist?
If so, what recommendation was made?
What remedial teaching is s/he receiving?
Any further remarks?





Teachers

At which school/clinic do you work?
What experience do you have in Special Needs?


Please print this form and send it with a cheque made payable to The Cheshire Dyslexia Association to:


The Secretary,
Cheshire Dyslexia Association
South Cheshire College
Dane Bank Avenue
Crewe
Cheshire
CW2 8AB
Tel: 01270 668600

Annual subscription@ £20 a member
Students on full time courses @ £5 each
Donation
Cheque enclosed
I am a UK taxpayer and would like the Cheshire Dyslexia Association to claim tax on all my donations until further notice
 Gift Aid

Charity number: 504184

NB. Information from this form will be kept on a database.

A postage stamp would be appreciated