Membership test page - Scotmid Co-operative

Application Form

"*" indicates required fields

This field is hidden when viewing the form

Unique ID

Title*

If employee, what store number?

Name*

Your Address*

This field is hidden when viewing the form

AddressType

Daytime Phone Number*

Mobile Phone Number

Email*

Date of Birth

This field is hidden when viewing the form

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*

This field is hidden when viewing the form

Date

This field is hidden when viewing the form

si_ContactType

This field is hidden when viewing the form

Joining Method

CAPTCHA

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

Comments

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