MEMBERSHIP APPLICATION FORM

WOLSEY ROAD CLUB

I wish to become a member of the WOLSEY ROAD CLUB

Title ________________________________________________________________

Name (In Full) ________________________________________________________

Address ______________________________________________________________

Postcode_____________________________________________________________

Date of Birth: ___________

Tel: ___________________

Mobile: ________________

Email: _________________

Subscription Category (Please Tick):

Category	Comments	Cost
Senior ___	Over 18 years	£10
Junior ___	16 – 18 years	£5
Juvenile ___	12 – 16 years	£5
Infant ___	Under 12 years	Free
Second Claim ___		£5

Please make cheques payable to “Wolsey Road Club”

Send application form and cheque to:

Mrs O.B. Forsbrook

Rondo

Lower Farm Road

Ringshall

Stowmarket

IP14 2JE