Q.1
My name is: *



Q.2
My phone number is: *

Q.3
My email address is: *

Q.4
My subscription rate is* (*Discount will be deducted where appropriate): *

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

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

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