APPLICATION FOR MEMBERSHIP

NAME  (Mr./Mrs./Ms./Master/Miss: __________________________________
(Block Capitals Please)

ADDRESS_____________________________________________________________________

______________________________________________________________________________

 Post code______________ TELEPHONE NUMBER_____________________
                                                                 (With exchange/STD)

MOBILE NO: _______________________________ FAX NO: __________________________

 EMAIL ADDRESS___________________________

I hereby enclose cheque/postal order/cash for the sum of  £……….. being my annual subscription.

Fees: Family £7        Single  £3       Junior £2          for the year. 

Please make cheques/Postal Orders payable to the ‘Northampton and District Poultry Club’.

Signed……………………………………….  Date………………………………….

Thank you for your application for Membership of the Northampton & District Poultry Club.

Print - fill out your details & then return this completed form to the club secretary:
Mr J. Messenger  High House, Raunds Road, Hargrave, Wellingborough, Northants. NN9 6BW