Brick Central New Member Form
Full Name
Your answer
Date of Birth
MM
/
DD
/
YYYY
House Name/Number & Street
Your answer
City
Your answer
County
Your answer
Postcode
Your answer
Email Address
Your answer
Confirm Email Address *
Your answer
Phone Number
Your answer
How did you hear about Brick Central ?
Your answer
SHOWS AND DISPLAYS
Are you interested in displaying at Brick Central hosted shows ?
What type of display do you currently have, or plan to build ?
Your answer
MEMBERSHIP
I am 18 years of age, or over
To make payment please visit www.BrickCentral.org/membership/
Your answer
PayPal Transaction ID
Your answer
Membership runs from 1st April to 31st March each year.
By signing this form I agree to become a member of and abide by the constitution of the Brick Central LUG. Please type your name in full to represent your electronic signature
Signature of applicant
Your answer
Date
MM
/
DD
/
YYYY
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.