Membership Application Form

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=90 BGCOLOR="#006699" TEXT="#080000" bgproperties="fixed" background="015285a1erlcgo.png"> <div> <FONT SIZE="5" COLOR="#FFCC66" FACE="Arial" ><B>Bob F Burns G3OOU</B></FONT><B>     |     </B><A HREF="index.htm" TARGET="_top" TITLE="Bob F Burns G3OOU"><U><B>home</B></U></A></div> <div> back to  <A HREF="id3.htm" TARGET="_top" TITLE="Crystal Palace Radio Electronics Club"><U><B>Crystal Palace Radio & Electronics Club</B></U></A></div> <div> </div> </td> </tr><tr> <td valign="top" width=190 BGCOLOR="#FFCC66" TEXT="#080000" background="013d4c00dkelyh.png"> <div> <A HREF="id22.htm" TARGET="_top" TITLE="About Us"><U>About Us</U></A></div> <div> <A HREF="id58.htm" TARGET="_top" TITLE="Club Projects"><U>Club Projects</U></A></div> <div> <A HREF="id14.htm" TARGET="_top" TITLE="Contact Us"><U>Contact Us</U></A></div> <div> <A HREF="id29.htm" TARGET="_top" TITLE="Notice Board For Sale and Wanted"><U>Notice Board - For Sale and Wanted</U></A></div> <div> <A HREF="id17.htm" TARGET="_top" TITLE="Meeting Details"><U>Meeting Details</U></A></div> <div> <B>Membership Application Form</B></div> <div> <A HREF="id60.htm" TARGET="_top" TITLE="Newsletters"><U>Newsletters</U></A></div> <div> <A HREF="id55.htm" TARGET="_top" TITLE="Other Radio Clubs"><U>Other Radio Clubs</U></A></div> <div> <A HREF="id13.htm" TARGET="_top" TITLE="Program of Activities for 2009/10"><U>Program of Activities for 2009/10</U></A></div> <div> <A HREF="id18.htm" TARGET="_top" TITLE="Spring Sale"><U>Spring Sale</U></A></div> <bR> </td> <td valign="top" height=390 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <I>Membership Application Form</I></div> <bR> <div> If you would like to become a member of the Crystal Palace Radio and Electronics Club please print this form, fill in the details about yourself and send it with your remittance to the Secretary or take it along to a meeting.</div> <bR> <bR> <div> Title: . . . . . . . . . . . . .          Callsign: . . . . . . . . . . . . . . . . . . . . . . . . .</div> <bR> <div> Initials:. . . . . . . . . . . .          First name: . . . . . . . . . . . . . . . . . . . . . . .</div> <bR> <div> Surname:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .</div> <bR> <div> Address:</div> <bR> <div> Line 1: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . </div> <bR> <div> Line 2: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . </div> <bR> <div> Line 3: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . </div> <bR> <div> Line 4: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . </div> <bR> <div> Postcode:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . </div> <bR> <bR> <div> Telephone: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .</div> <bR> <div> Packet Details: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .</div> <bR> <div> Email Address: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .</div> <bR> <div> RSGB Member      Yes / No</div> <bR> <div> Special Interests:</div> <bR> <bR> <div> I <U>object</U> /<U>do not object</U> (delete as appropriate) to these details being entered on a computer for the express purposes of maintaining the club membership records.</div> <bR> <div> I <U>object</U> / <U>do not object</U> to my name, email address and telephone number being circulated on a membership list to other members of this club.</div> <bR> <bR> <div> Signature . . . .. . . . . . . . . . . . . . . . .          Date . . . . . . . . . . . . . . . . . .</div> <bR> <div> _______________________________________________________</div> <bR> <div> Please include your cheque/Postal Order for £................. for your annual subscription.</div> <bR> <div> For club use: Membership Number . . . . . . . . . . . . . . . . . . . .</div> <bR> </td> </tr></table></body>