Membership Application Form

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Membership Application Form

Title:_________________________  Callsign / BRS:_______________________

Initials:_______________________  First name:________________________

Surname:_________________________________________

Address:

Line 1:___________________________________________

Line 2:___________________________________________

Line 3:___________________________________________

Line 4:___________________________________________

Postcode:_________________________________________

Telephone:________________________________________

Email Address:____________________________________

RSGB Member  Yes / No Packet Address:______________________________

Special Interests:_________________________________________________________

I prefer to receive the club newsletter by:   Email (Adobe Acrobat format)   /   Post

I  object  /  do not object  to these details being entered on a computer for the express purposes of maintaining the club membership records and distributing the newsletter.

I  object  /  do not object  to my name and telephone number being circulated on a membership list to other members of this club.

Signature:____________________________  Date:_______________________

Please send your completed form and cheque/P.O. for £................. made out to Crystal Palace Radio & Electronics Club for your annual subscription to the club treasurer (see newsletters) or bring it to a club meeting.

_________________________________________________________________

For club use only: Membership Number . . . . . . . . Circulation: Secretary, Treasurer, Chairman

Click here for contact details.

Click here to download an application form