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Raynor Angling Club Application for membership Full Name ............................................................... Address .............................................................. ............................................................... .............................................................. Post Code ............................... Telephone Number including dialing code .............................. Email Address ................................................................. Current Vehicle Make ............................ Colour .............. Registration Number.................. Date of Birth .................... I am applying for Full / Senior Citizen / Junior Membership Are you a member of any angling team Yes / No if Yes which one ............................... Are you in receipt of any sponsorship from any source Yes / No If Yes who ............................. I enclose my cheque for £.......... as my membership fee made payable to "Raynor A.C."and a passport sized photograph of me
Please include an A5 size stamped addressed envelope with 2 x First class stamps for reply
Full membership fee £25:00 Senior Citizen membership fee £19:00 Junior membership fee £15:00
Subject to my application being approved I agree to abide by the club rules and all notices and instructions in force by Garlands Shooting Grounds.and at Camp Farm Lake Signed ................................................. Date ........................... All of the information submitted will be held on record by the club secretary Please post this completed form to Mr. R.J.Mellor Raynor Angling Club 15 Sycamore Avenue Newhall Swadlincote Derbyshire DE11 0NJ
Telephone 01283 212180 Mobile 07951175715
Email: rjmellor@talktalk.net Website http://www.raynor-angling-club.co.uk
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