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CHESTERFIELD & DISTRICT BRANCH (NORTH DERBYSHIRE REDS)  *Please note: ALL forms must be completed and returned by 12th July 2010. Any member who has not returned their completed form by this date will NOT be allowed membership for the season, and therefore be unable to attend matches. They would then have to re-apply for membership next season, and pay the full, re-joining fee. If you wish to cancel your membership, please tick the relevant box, complete & return the form as normal. *Membership renewal includes your first ‘B’Class Match booking to be re- claimed via the branch’ Match Booking Form’. Subsequent bookings may also be included on this form or via the normal meansMEMBERSHIP RENEWAL FORM 2010-2011 SEASON Membership subscription charges: Senior Membership (16 and over):                 £ 64.00 Junior (Under 16):                                           £ 57.00   Students (full time), O.A.P. & UB40:             £ 60.00 *Please complete ALL SECTIONS in BLOCK CAPITALS ONLY NAME: ……….……………………………………………............................ ADDRESS: …………………………………………………………………… ………………………………………………………………...........................     POST CODE ………………………DATE OF BIRTH: …………………… HOME TEL No: ………………………MOBILE: ………………………….  E-MAIL ADDRESS: …………………………………………………………    FAN CARD NUMBER (current holders only): ………………                              MEMBER TYPE:(please circle) SENIOR    JUNIOR   STUDENT/OAP/UB40   CANCEL   Declaration – I hereby agree to abide by all Branch rules and regulations   SIGNATURE: …………………………………………….  DATE: …………………………….(Parent or guardian to countersign for juniors).   Please make cheques / postal orders payable to:L.F.C.I.S.C. CHESTERFIELD & DISTRICT BRANCH). Return completed form to: Pete Rawson 22 Church Meadows, Calow,Chesterfield, DerbyshireS44 5BP
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