Membership Details

If you would like to become a member or renew your membership, fill in the  form  below

& return it to : Maureen Stock (Membership Secretary)

1 Victoria Close, Rushden, Northants. NN10 0DG

  Or hand it in at  the next  vagabond walk

The membership year runs from January 1st to December 31st

Fees are as follows:

Individual Membership         £3.00 per annum

Family Membership              £7.00 per annum (2 Adults & 2 children under 16)

Individual Life Membership   £40.00

Please make cheques to " Ise Valley Vagabonds "

FAMILY MEMBERS ONLY

Ise Valley Vagabonds

Forename:


Surname:


D.O.B (If under 16)


Address:


Post Code:


Home Telephone:


Mobil:


E-Mail:


1


2



Children’s Names

1


2



D.O.B



DECLARATION

DATA PROTECTION: I understand that the information supplied on this form will be held both manually and electronically for the use of (elected) officers of the above club. The information will not be passed to other bodies without my express  permission. My signature below confirms that this is entirely acceptable to me. I also am aware that I may rescind this authority at any time.


Signed:____________________________Print:_______________________________________Date:__________



Parent Signature if under 18yrs___________________________Print _________________________________       Date__________________