Application Form

Surname: ___________________________   Forename ____________________  Date of Birth__________________

Qualifications_________________________ Profession____________________  Interests______________________

Address____________________________________________________________________________________________

Postcode_______________________________ Email_________________________ Ethnicity_____________________

Telephone  Home:_____________________  Office: _________________________ Mobile________________________

I  apply for membership to Asian British Connection (ABC) Think tank and shall abide by all regulations.

Please find enclosed cheque in name of Asian British Connection (ABC) covering annual membership fee of £20

Signature____________________                                              

Please post application form and cheque to 92 Long Lane, Ickenham, Middlesex, UB10 8SX, England, UK