Join

To join the association please complete and submit the form below. If you are unsure of your eligibility either complete and submit the form with details of your query or email us at treasurer@cukpa.org.uk.

N.B. The form requires your personal information which may not be 100% secure when transmitted, if this worries you then please don’t enter any details but email davpou@blueyonder.co.uk with a “Request to join CUKPA” in the Subject line. Dave Poulter will then get back to you with an application form which can either be posted or emailed back to him.

The subscription structure is:

– £10.00 if you are under 80 years old
– £5.00 if you are 80 or over or are a surviving spouse.

Title:
First name:
Middle initial(s):
Surname:
Spouse name:
Address 1:
Address 2:
Town:
County:
Postcode:
Telephone:
Email:
Chevron company:
Birth year:
Retirement year:
Payment method:
Additional info:

Would you prefer to receive the association magazine Insight by:
 Email Post

Allow us to send your address details to other members?
 Yes No


Alternatively click here CUKPAApplicform18 to download a printable form.

Please send completed forms to  Dave Poulter, 98 Goshawk Drive, CHELMSFORD, Essex, CM2 8XP.