Q.1
My name is: *



Q.2
My phone number is: *

Q.3
My email address is: *

Q.4
I wish to pay my membership subscription at the rate of*: (*Discount will be deducted where appropriate):

Q.5
I wish to join the 100 Club by adding £5.00 monthly subscription(s) to my direct debit

Q.6
I wish the FULL member discount to be applied to my subscription: