Application for Membership

Please complete the form below.

Name(s):

Title……… Forename…………………………….…….. Surname……………..………………………….…

Title……… Forename…………………………….…….. Surname……………..……………….……………

Address…………………………..…………………………………………………………………....………….

……………………………………...……………………………………………………………..………………

Telephone ……………………………….. Email address ………………………………….………….…….

Signature…………………………………………..…….. Date………………………….…………..………..

The Annual Subscription for membership of the Staveley Roundhouse is £10 per person or £16 for two people at the same address. The subscription is due on 1st May each year; new members joining after 1st January are covered until the May of the following year. When completed please return this form to me along with confirmation of your membership payment. Please indicate your chosen payment option:

Enclosed cheque made payable to Staveley Roundhouse

Bank transfer* (Surname and initials as reference)

Set up of annual standing order* (Surname and initials as reference).

*Bank transfers/Standing orders made payable to:

Staveley Players Roundhouse

Barclays Bank account number: 43419606, sort code 20-45-28

Membership Secretary:

Lisa Bolton

Laneside, Staveley LA8 9QZ

Secretary.StaveleyRH@gmail.com