The Merseyside Boxer Club

Membership Application/Renewal

Surname: …………………………   Title: …………Mr/Mrs/Miss/Ms/Master

            Forename(s): ………………………………………….

Address: ……………………………………………………………………

………………………………………………………………………………..

………………………………………………………………………………..

Postcode: …………………......

            Telephone Number: ………………………………                                            

E-mail: ………………………………………………

Type of membership: …………………..  (Subject to committee ratification)

(joint/single/junior)

Member introducing: …………………………………………………………..

Membership Fee: Single £5.00, Joint £7.00, Junior (Under 16) £0.50

Amount Paid: £ …................ 

Receipt number: ……………

Date of application : ……/……/……                    Date of ratification: ……/……/……

Return to Secretary:   Marion McArdle

12 Beeston Dr. Sefton, Merseyside, L30 7QQ