100 Club

Membership Application Form

I wish to purchase ….......units in the 100 Club at a cost of £3 per unit per month.

The draw will take place at the Burridge Club Committee Meeting, held on the 3^rd Monday of each month. Commencing on 21^st June 2010.

I agree to pay for the unit(s) with an annual or monthly standing order subscription, or an on-line payment.

Numbers drawn will only be paid out if the member is up to date with their subscriptions.

I agree to abide by the 100 Club rules.

Signed……………………………………………

Print name……………………………………….

Address………………………………………….

………………………………………….

Date……………….. Contact Tel No………………………Email:.....................................

Method of payment

On-line payment to Burridge Cricket Club, Lloyds Bank

Sort Code: 30-13-95, Account No: 00896499

By monthly Standing Order to above account, (on 1^st of the month).

By cheque (for annual subscription) payable to Burridge Cricket Club.

You may complete this form and scan/e-mail or post to any of the Officers listed below.