HASSRA Membership Card Request Coupon Please complete all sections fully
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HASSRA Membership Card Request Coupon Please complete all sections fully using BLOCK CAPITAL LETTERS. Please do not use this form to apply for a replacement card. Please contact HASSRA NW for a replacement card coupon. Please note from August 1st 2007, you be charged £5 for your second replacement card. Membership Cards will be dispatched within 6 weeks of receipt of your coupon. Title (Mr, Mrs, Miss, Ms, Dr etc) Surname First Name Home Address Home Postcode Daytime Phone Number (including Dialling code) Email Address Staff, Payroll or Pension Number Office Location (name) or ‘Retired’ Membership Yes No Are you a currently subscribing HASSRA member? Date / / Completed Coupons should be returned to HASSRA North West: - By Courier: HASSRA North West – (Card Launch) Room 104a Accrington CSA By Post: HASSRA (Card Launch) PO Box 183 For Official Use Only Accrington Regional Ident BB5 6WS Data Input Card Number Card Issued Data Protection The above data is requested to support the effective administration of the HASSRA Membership Card launch initiative and the general administration of HASSRA’s programme of benefits and opportunities to members. Data will be compiled, retained and managed in accordance with appropriate Data Protection legislation and guidance. Data collected as a result of this exercise will not be passed to any third party organisations for their use.