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Registration Form for BCGBA Membership |
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County Association: |
BRITISH PARKS CGBA |
County Membership
Number: |
BCG |
10021 |
PA |
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Club Name: |
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Club Membership
Number: |
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Number
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Mr/ Mrs/Miss /Ms |
First Name |
Name 2 |
Surname |
Gender M/F |
Date of Birth |
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~ Applications for a Replacement Card only |
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Address |
Post Code |
Email |
Tel: Landline |
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Tel: Mobile |
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Ethnic
Origin * |
Disability or Serious Illness * |
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* Please see notes for further information on
these two boxes |
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Card to be returned to: |
Club Secretary |
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Please tick your |
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Applicant |
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preferred option |
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I enclose a cheque to
the value of £ (£10
for a new player, £3 for a replacement card) |
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Cheque to be made payable to: B.P.C.G.B.A |
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Send to
County Registrar:RAYMOND LORIMER |
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Address:170
WHITELEES ROAD, LITTLEBOROUGH, LANCASHIRE, OL15 8DU |
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Phone:07742501392 |
E-mail: rayjlorimer@aol.com |
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If you wish to make an electronic payment
please contact the County Registrar. |
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Please note: The information given on this membership registration form
will only be used in connection with your BCGBA Membership and will not be
shared with any other organisation. |
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