Open Door 200 Club - Membership Form

(Please print a copy of this form, complete it and post it to the address below together with your cheque or cheques.)

Name:__________________________________________

Address:________________________________________

______________________________________________

Post Code:___________________

Tel No:______________________

E-mail address (if you have one)__________________________________

I would like to join the Open Door 200 Club and wish to purchase _______ number(s) for the duration of the club (30 weeks).  I understand that the cost is £30 per number (£1 per week).  I enclose, for each number requested:

A cheque for £30 dated today or

A cheque for £10 dated today and two post dated cheques for £10 each, dated 3rd July 2006 and 11th September 2006.

(Please delete the option that does not apply.)

Cheques should be made payable to 'The Open Door 200 Club'.

Signed _________________________ Date ____________________

Please return the completed form and your cheque(s) to:

The Open Door 200 Club
c/o 1 Roslin Road Irby
Wirral CH61 3UH

Or give them to Patsy Brady in person.

We will let you know which number(s) have been allocated to you.

(Please print a copy of this form, complete it and post it to the address above together with your cheque or cheques.)