South Cumbria Dyslexia Association
Membership Form
Print this form and return the completed form to
SCuDA Administrator/s Dawn Elsworth/Sally Dyer
South Cumbria Dyslexia Association
Cambridge Primary School
Cambridge Street
Barrow-in-Furness
Barrow Office Tel 01229 820998
Kendal Office 01539 742632
Name...........................................................................
Address........................................................................
...................................................................................
...................................................................................
Post Code.....................................................................
Tel No..........................................................................
E mail...........................................................................
If you are the parent of a dyslexic child, or have a child you think may be dyslexic may we have :
Child's Name.............................Date of Birth..................
School.........................................................................
I enclose a cheque for £11 made payable to SCuDA
Signed.........................................Date.........................
When you join we will send you details of Gift Aid
(This would make your subscription worth £3.08 more to SCuDA)