AFIA Application Form

AFIA Application

Date

Day

Month

Year

Name *

Your Address *

Enter your address below

Country *

Address 1 *

Address 2

Town/City *

Postcode *

Email Address *

Phone Number *

When did you/your family last have a holiday/break? *

Have you previously received a holiday from Mothers’ Union? *

Yes

If yes, when was this?

Current Situation *

Please outline your current situation and how a holiday might help you.

Beneficiaries *

Please name all people who would be included in the holiday, their relationship to you and their ages.

Referee *

Please provide us with the contact details of a professional referee, such as your GP, a member of the clergy, teacher, support worker etc. who is aware of and willing to support this application. Your application cannot be considered without this information.

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AFIA Application Form