Become A Member

About You
Name of business This is the number under which membership will be registered

Proprietor/s Surname (Mr / Mrs / Miss / Ms / Other)

Forename/s

Your Contact Details This is the address we will use to promote your business and it will be published in our Directory of Members and on our website
Business Address




Business Telephone

Business Fax

Mobile Telephone

Website Address

Email Address

Mailing Address and Telephone Number - not for publication, if different from above




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References
Bank Reference: Name And Address Of Bank




Trade References Please name as referees two professional dealers (at least one of whom should be a current LAPADA member) who have known you for a minimum of three years
Name, Address, Telephone Number




Name, Address, Telephone Number




Declaration
By checking this box I understand that compliance with the Lapada By-law and Code of Practice and payment of the annual subscription are conditions of my membership of the association
Submit Application

About You