2010

(PLEASE USE CAPITAL LETTERS)

 
Surname  (Mr/Mrs/Ms) ………………………………………………

First Name(s)   …………………………………………………………

Address   ………………………………………………………………

                  …………………………..  Post Code   ……………………

 e-mail address  …………………………………………………………

Telephone Number   ……………………………………………………

Date of Birth (Important for accurate records)   ………………………

Membership Number   ………………     Date ………………………… 

TYPE OF RENEWAL REQUIRED:

 Carlton Hse Club Membership Renewal  (Male/Female)    £ …………

(2010 £13.00)

 With C.I.U 2010 Pass Card Renewal                     £ …………

(2010 £16.00)

(For those with C.I.U Associate Membership Card)

 Other Items: …………………………                  £ ……………

(Key Fob £4.00)   (Club Card Wallet £5.00)      

                                                           TOTAL  £_________ 

 PLEASE ENCLOSE WITH YOUR MEMBERSHIP CARD

Contact email     admin@carltonhouseclub.co.uk

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