Name:                                                         Date:


  Including post code

  Telephone:                                            Mobile:


  Family member


  Junior members              Signature of parent:

  under 18 years of age

                                Signature of guardian :

  While a member,I agree to abide to the rules of the club.


   Club Fees:      Adult               Junior            OAP           OAP Family          Family

                       £31.00            £20.00        £21.00           £27.00             £42.00

   Plus £9.00 Insurance


   Added to Secretaries records                  Added to treasurers records

   Please print off this form and return it to the club treasurer  

   Karina Brookes, 174 Pottersfield, Harlow, Essex. CM17 9DD. Along with a    cheque to cover membership.

   DATA PROTECTION ACT:   The above personal information will be kept on a    computer based file, which will be circulated to all club members. If you    object    to this please tick here.        But your membership service may be    impaired.

Harlow Essex

Moorhen Model  Boat Club