University of the West of England
Staff Association

Application for Membership

Title:

Full Name:

Phone Ext:

Faculty/Dept/Section:

Room number:

Campus:

Other campus:

E-mail Address:

Hours Worked:

Please deduct from my salary the sum of £1.00 each month until further notice in respect of my subscription to UWE Staff Association.

My Pay Reference
(if known):

Signature (if printing):

Date:

Completed application forms should be returned to:

Secretary
UWE Staff Association
FC00, Felixstowe Court
Frenchay Campus.

For Staff Association use only
Passed to Human Resources by (initials):	Date:
Membership number issued:	Date:
Date card issued:	Date: