FULHAM SUPPORTERS’ TRUST MEMBERSHIP			 


Please return this application form to:

BACK TO THE COTTAGE, PO BOX 44170, LONDON, SW6 6XH.

No stamp required.

Your welcome pack(s) will be sent within 30 days.


Name:________________________________________________________________

Address: ____________________________________________________________

_____________________________________________________________________


Email: ________________________________Contact tel. no:______________


Please tick membership type below. If  Junior please state age.

[  ] Adult      [  ] OAP      [  ] Junior (under 16 ) 


Second person at same address:_______________________________________

Please tick membership type below. If  Junior please state age.

[  ] Adult      [  ] OAP      [  ] Junior (under 16 ) 


Third person at same address:________________________________________

Please tick membership type below. If  Junior please state age.

[  ] Adult 	[  ] OAP      [  ] Junior (under 16 ) 



Total number of annual adult memberships required at £10 each: ______


Total number of annual child/OAP memberships required at £5 each: ___


Additional donation towards the Trust’s work: _______________________


Please make your cheques or postal orders payable to 

"BACK TO THE COTTAGE"


Total: £____________