Membership test page - Scotmid Co-operative

Application Form

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Unique ID

Title*

If employee, what store number?

Name*

Your Address*

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AddressType

Daytime Phone Number*

Mobile Phone Number

Email*

Date of Birth

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Age Calculation

Scotmid Membership

Credit Card*

Please read the following statements and sign and date below to agree with them:

I am over 16 and live in Scotmid's trading area.
I am committed to Scotmid Co-operative remaining a co-operative and I support co-operative values and principles.
I agree to the rules of Scottish Midland Co-operative Society Limited (Scotmid). You can view our rules by visiting www.scotmid.coop.

Signature*

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Date

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si_ContactType

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Joining Method

CAPTCHA

You must be 16 years or older to submit this form.

This field is for validation purposes and should be left unchanged.