EAGLEY JAZZ CLUB MEMBERSHIP APPLICATION
Please complete in BLOCK CAPITALS and send this form together with your remittance to Bernard Callaghan, at
45 Harefield Drive, Didsbury, Manchester, M20 2SZ. Cheques payable to Eagley Jazz Club. (*delete as appropriate) Membership Subscription for 12 months: Single £5.00; Double (ie spouse/partner) £7.50
FULL NAME: Applicant 1
Mr/Mrs/Miss/Ms*
Applicant 2
Mr/Mrs/Miss/Ms*
ADDRESS
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POSTCODE
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TELEPHONE NO
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DATE OF BIRTH (if under 18)
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How did you first learn about Eagley Jazz Club?
............................................... EXISTING MEMBER?
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I/we* apply for 12 months membership of "Eagley Jazz Club" and enclose a cheque for £5.00/£7.50*
Signed
Date
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(only one signature required)
Venue: Dunscar Conservative Club, Hardmans Lane, Bromley Cross, Bolton, BL7 9W 01204 303661
For further details contact B Callaghan 0161 445 9237 or G Gilpin 01204 303705
Cash/Cheque £............... Date .................Initial
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