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 The Malta Hospice Movement

 
 I would like to apply for new membership / renew membership.
 
  Mr/Mrs/Ms/Dr:__________________________________ ID:___________________
 
  Address:_____________________________________________________________
 

  Telephone:__________________ Email:___________________________________

 

 I enclose €10 being my membership fee for the year 2010.

 (Cheque payable to: The Malta Hospice Movement)

 
 

Signature ________________________     Date ________________
 
  Due to the introduction of the Data Protection Act, should you not wish Hospice to have your details on the database please tick here _________and return to us.
 

 Thank you for your support

 Please encourage a friend to apply for membership

 
Being a member means you are actively supporting the services of the Movement. You are entitled to attend and vote at the AGM and you will be kept informed of Hospice activities by receiving the annual magazine.
 

 The Malta Hospice Movement, 39, Good Shepherd Avenue Balzan BZN 1623.

 Tel: 21440085 email:  

 

 
 
 
 
 
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