Membership Form 28,18,18,18,18 PrefixMr.Mrs.Ms.Mx.MissDr.Prof.First Name *Last Name *Street Address *City *State/Province *ZIP / Postal Code *Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemen Arab Rep.Yemen DemocraticZambiaZimbabweTel NoMob No.Email AddressBeesDo you have Bees AlreadyYesNoNumber of ColoniesMy apiaries are located at We are informed by local farmers when and where they are spraying. The information entered here is used by our Spray Liaison Officer to determine who will be affected by the spraying. All information is treated with the strictest confidence.MembershipNew / Renewal *New MembershipRenewalMembership Class *Full - £28Partner - £18Associate - £18Country - £18Junior - £18Late Pay SurchargeRenewal Late Pay Surcharge Applied - £5Only applicable from the 1st December to 31st October. Not Applicable to New MembershipsMembership Price£Membership to be paid by BACS / Internet Banking into the CBKA Account. Account Name: Cleveland Beekeepers Association Sort Code: 40 43 11 Account Number: 91063758 Please put “Mem and your name” in the reference field.Gift AidGift Aid *YesNoI want to Gift Aid my donation and any donations I make in the future or have made in the past 4 years to: Name of Charity - Cleveland Beekeepers Association I am a UK taxpayer and understand that if I pay less Income Tax and/or Capital Gains Tax than the amount of Gift Aid claimed on all my donations in that tax year it is my responsibility to pay anydifference. Please notify the charity if you: Want to cancel this declaration. Change your name or home address. No longer pay sufficient tax on your income and/or capital gains. If you pay Income Tax at the higher or additional rate and want to receive the additional tax relief due to you, you must include all your Gift Aid donations on your Self-Assessment tax return or ask HM Revenue and Customs to adjust your tax code.Terms and Conditions *Cleveland Beekeepers Association records your membership data on our members register. It will be stored in accordance with the GDPR. Your membership data will be shared with the British Beekeepers Association, Cleveland Beekeepers Association mailing list, the Animal and Plant Health Agency (APHA) BeeBase and their Bee Inspectors. No personal details will be made available to anyone other than the above organisations. I agree to abide by the rules of the Association as laid down in the constitution.This form will redirect you to another page once submitted.SubmitPlease do not fill in this field. Once payment has been received it can take up to a week for memberships to be processed. Please be patient and we will be in touch shortly.