If you would like to join our audience
please copy the following two-page application form and paste and print it out as an A4 sized Word document.
Complete all information on the first page and then arrange for one of the alternative certificates on the second page to be signed by a qualified person.
Then please post to our address and we’ll be in touch with you shortly afterwards.
_______________________________________
West Shropshire Talking Newspaper
Fletcher Centre, Cross Hill Shrewsbury SY1 1JE
APPLICATION FOR FREE MEMBERSHIP
Our weekly USB memory stick recordings will play on digital radios with USB sockets, on computers and on special USB player units._____________________________________________________
1 Please have your name and contact details completed below..
2 Please have the relevant certificate completed overleaf.
3 If you live within the western half of Shropshire please tick the line if you do not have any of the above means of playing a memory stick and we will provide a player on free loan: _________
(loan players are not provided outside our area)
4 Send your application to our address above.
_________________________________________________________________________________________
NAME
___________________________________________
ADDRESS
___________________________________________
___________________________________________
POSTCODE
___________________________________________
TELEPHONE NO.
___________________________________________
___________________________________________
Royal Mail Regulations require that one of the Certificates overleaf is completed before we can use the ‘Articles for the Blind’ free post.
_____________________________________________Page 1 of 2
CONFIDENTIAL ~ W S T N APPLICATION - PAGE 2.
Royal Mail Regulations require that one of the Certificates below is completed before we can use the ‘Articles for the Blind’ free post.
_____________________________________________________
FOR REGISTERED BLIND APPLICANTS
I confirm that the applicant named overleaf is Registered Blind.
SIGNATURE
___________________________________________
NAME and LOCAL AUTHORITY POST HELD (please print)
___________________________________________
DATE
___________________________________________
ADDRESS
___________________________________________
___________________________________________
FOR PARTIALLY-SIGHTED APPLICANTS
I confirm that the applicant named overleaf has close-up vision with spectacles which is N12 or less.
SIGNATURE
___________________________________________
NAME and QUALIFICATIONS (please print)
Opthalmologist/Doctor/Opthalmic Optician
___________________________________________
DATE
___________________________________________
ADDRESS
___________________________________________
___________________________________________
___________________________________________
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