Ken Colyer Trust Application Form

MEMBERSHIP APPLICATION FORM

If you wish to support the Ken Colyer Trust or are interested in hearing about the objectives and activities of the Trust, please print out* and complete the form below and return to:

Membership Secretary
Ken Colyer Trust
63 Rydal Gardens, Hounslow
Middlesex TW3 2JJ

Please Tick Brackets As Required

( ) I enclose my individual subscription
(Renewable 1st April) of £10.00

( ) I enclose my family annual subscription
(Renewable 1st April) of £13.00
(PLEASE MAKE CHEQUES PAYABLE TO KEN COLYER TRUST)

( ) Please forward further details in the first instance

Please Print Clearly
Name(s) ........................................................................
Address .........................................................................
.....................................................................................
.....................................................................................
Postcode ........................................................................
Telephone No: ................................................................
Fax No: .........................................................................
email: ...........................................................................

If you know of anyone interested in becoming a member of the Trust, the Membership Secretary will be pleased to send them a form. Please write their name and address on the reverse of this form.

* to print out this form select 'print' in the file menu of your browser