Application form to receive Kiran Talking  Newspaper




                                                                                                            AALO          KIRAN          ROSHNI            
Application form – Tape Service & Membership                  Membership/Listener No. (Office use)
1. Title:
2. Surname:___________________Forenames: _____________

3. Address: ___________________________________ 
                        _____________                                           Postcode:_____

4. Telephone: -------------------------
5. Date of Birth (optional) --------------------------
In order to receive our talking newspapers, please, complete sections 6, 7 and 8. The talking newspapers or books are made available for listening free of charge to all those who are blind, partially sighted or visually impaired.

6. I am …(tick  only)                            registered BLIND 
                                                               registered PARTIALLY SIGHTED
                                                                have N12 or worse eye sight

I am registered with (name of the Council) ______ __________________________

If not registered, please, provide a note from a medical person certifying that you are unable to read standard print with corrected vision i.e. with spectacles.

7. Mother tongue:             Gujarati,_______   Hindi, _____      Bengali_____       Other languages ____

8. I would like to receive (tick as required) KIRAN( Gujarati), ROSHNI (Hindi) AALO (Bengali – monthly)

Would you like to become a voting member of the organisation, enabling you to participate fully in all aspects of our activities including policy development and management, then complete section
9 below, if not move to section
10. This is optional.
           I wish to join as a Life Member and enclose a one-off payment of £10.
(Cheques or postal orders to be made payable to Kiran Talking Newspapers)

Now, please, sign and return the form to: The Secretary, Kiran Talking Newspapers, 8 Cameron House, 80 Pound Lane, LONDON. NW10 2HT

10. Signature_________ _______________________ Date_________________

11. Name of the person signing on behalf of the applicant, where appropriate