Membership Form

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@honeypot('pokhreli_name', 'pokhreli_time')

Member Contact Information

Full Name

Email Address

Phone

Address 1

Address 2

Town / City

Postal Code

Address in Nepal

Membership Type

Membership Type Select Membership Type Life Member (£ 50) General Member (£ 10)

Payment Method Select Payment Method Cash Card

Membership Information

Principal Life Member

Spouse Life Member

Email

Phone

Address

Declaration

1. Photographs of Pokhareli Manch UK members may be used in various PMUK communications incl. the newsletter and website. Group photographs taken at PMUK events may be used without identifying individual members. For individual photographs, please indicate your permission for use
Yes       No   

2. Have you been convicted of a criminal offence which is not spent under the Rehabilitation of Offenders Act 1974?
Yes       No   

Criminal Offence Details

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