I wish* / do not wish* to become a member of The Association

Please complete ALL sections and return the ENTIRE page


To The A.D.A. Membership Secretary: Ted Hazelden, 23 Dunsdon Avenue, . GUILDFORD, GU2 7NX,


or via Mr James Robinson, Head of Sixth Form


Name/ Initials : Surname: .


Address : ..



Post Code: ..

Years at School From to ..



We send ADA Newsletters via Email if we have an address for you . (About 2 or 3 times a year)


Email Address: ...


I wish*/do not wish* my email address to be published in the Association Membership List


Telephone number


this is for office use only and will NOT be published)



I am* / I am not* applying for the ADA Bursary Award this year.


Any comments you wish to make:








Your Signature Date


New member form Mar 2010