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WORTHING & DISTRICT BKKS

MEMBERSHIP APPLICATION /RENEWAL FORM

              NAME:  ............................................................................................................

Partner's NAME   ...........................................................................................................

        ADDRESS:  ............................................................................................................

                       ..................................................................................................................

                       ..................................................................................................................

                       ..................................................................................................................

 POSTCODE: ...................................                    

 PHONE:  ......................................................  MOBILE: ................................................

 E-MAIL   ...........................................................................

                                                      Please tick if new member .....................

MEMBER

  DUES:      HOUSEHOLD SUBSCRIPTION:       £15.00    ........

                # (this includes all residents at the above address)

BKKS

MEMBER:         * YES/NO     BKKS No. (if known)         ...................................

W & D No.        ...........................                                       

OTHER KOI SECTION/CLUB MEMBER?               * YES/NO

IF YES, WHICH? (Primary first)

.................................................................................................................................

Total amount due £15.00  - please make any cheque payable to:

WORTHING & DISTRICT BKKS

Return to;   

                  Alison Plummer

                  6 Biscay Close

                   Littlehampton

                   West Sussex

                   BN17 6SW

                        I agree to abide by the rules of Worthing & District BKKS Section

         Signature: ..................................................................   Date: ...............................................