About your club
Club name
Number of club members
Contact details
Named contact for all communication
Contact postal address
Contact telephone number
Contact email address
Alternative contact
Club website
Data Protection (please tick)
Can we share your contact email address on our website?
Can we use your details to contact you about news and events from MAD Scotland?
Membership
Registration for a club membership is £50.00. This entitles your club to a lifetime membership. At registration we include five free association badges. Additional badges are available at a cost of £3.50 each (which includes postage). How many additional badges would you like?
I the undersigned (on behalf of ) agree that our members will support the aim of MAD Scotland by raising funds directly and through community involvement for freedom of mobility for all disabled persons in Scotland.
Signed	Date