General Secretary: John Dyer

Treasurer: Robin Green

www.thegsa.co.uk

General Services Association

Application Form: Membership/Membership Renewal

Membership type (price/annum). Please tick one
Corporate 10 members (400)
Corporate 21 30 members (700)
Corporate 11 20 members (550)
Corporate 30 members (800)
Individual (50)
Application Type

[please tick]

Membership

Membership Renewal

I, (Name):
Of (Organisation you work for):
Wish to apply for membership/membership renewal of The General Services Association, subject to the provisions of the
Memorandum and Articles of Association of the Company and to the Rules. I agree to pay to the company an amount of up to
1 if the company is wound up while I am a member or within a period of 12 months after I have left the company. I agree to
pay a subscription of the appropriate amount, as set out above on 1st of April 2009, and to pay any other membership fees
levied in accordance with the Companys Rules, by 1st of April in all successive years.

PLEASE USE BLOCK CAPITALS WHEN COMPLETING THIS FORM

Contact Details - Address
Phone Number/s

Membership No

E-mail Address: (Please print)

Most recent General Services Tutors Course Attended Please note that in order to be a full member of GSA you must
abide by requirements of Tutors/Senior Tutors policies regarding attendance of Tutors Update.

Initial Tutor Training Dates

Senior Tutor

Date of Most Recent Update

Senior Tutor

Tutor Type

Tutor

Assistant Tutor

Senior Tutor

Bespoke Tutor

Please complete the following sections to ensure information you receive is of most relevance to you:

Professional Group Most Aligned to Your Role/ Responsibilities:

Adult Mental Health
Lecturer/Training
Young People
Learning Disabilities
Older People
Brain Injury
Other
Specify

For Groups of Members Only:

Name of lead person

Signed:

Date:

Contact details for payment

How do you wish to be invoiced?
Name of person in finance paying the invoice
279135694.doc

By post
1

By e-mail

Contact details for the invoice [postal

address or e-mail address]
Purchase Order Number. For some organisations payments a PO is
mandatory.

Would you like a receipt?

Yes

No

GSA PAYMENT DETAILS

BACS PAYMENTS. This is the preferred method of payment
Bacs Payment
Bank Name & Address
Sort Code:
Account Name:
Payee Reference
Cheques
Make Cheques Payable to:
Send to:
E-mail

Barclay, Washington Branch, The Galleries, Washington, Tyne and

Wear
20-83-69
Account Number:
80281565
The General Services Association
Enter GSA Membership
General Services Association
The Treasurer, The General Services Association, Kemp House,
152 City Road, London EC1V 2NX
financeforthegsa@gmail.com

Return your completed application:

http://thegsa.co.uk/news/gsa-2014-membership-applicationOn-Line [preferred method]
renewal/
E-mail
jan.shand@thegsa.co.uk
The General Services Association, Kemp House, 152 City Road,
Post
London EC1V 2NX
FOR OFFICIAL USE ONLY
Membership number

Date Received

Web account created

E-mailed

Receipt

279135694.doc