Name *

First Name

Last Name

Phone Number *

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Mobile

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Do you give your consent for Millport Town Hall to store your personal information and contact you via email (where applicable) to reduce costs and environmental impact? *

Yes

No

Do you agree to act in the best interests of Millport Town Hall SCIO and support its charitable purposes as a member? *

Yes

No

Date *

By entering the date and submitting this form, you confirm that the information provided is accurate and that your submission counts as your digital signature.

MM

DD

YYYY