Just highlight the page and print off the highlighted section

Mold and District Reds
Cochion Yr Wyddgrug a'r Fro
Membership Form 

http://www.moldreds.co.uk
 
Formed July 2007

Membership Application Form Season 2011/2012

Name…………………………………....................................
 
Address………………………………………………………....

............................................................................................

............................................................................................


Contact Details ( for Mold and District Reds use ONLY )  

Tel No....…………………….........../Mobile ....……………………..........
 
Email…………………………………...................................
     
Age (if under 16) ......... 
  
Are you a season ticket holder? ……..Yes / No
Do you travel to away games? ............Yes / No
 
I wish to apply for (tick as applicable)
Adult (£5)
Concessions - Juniors & OAPs (£2.50)
Family (£10)
(Family Membership is 2 adults and up to 3 children )
  
Payment can be made via cash or cheque to a committee member or by cheque
posted to:
Rob Hughes, c/o  Mold Delivery Office, 18 Earl Road, Mold  CH7 1AA
Please make cheques payable to “Mold & District Reds”
  
If accepted I agree to be bound by the Association's Rules and Constitution
 
SIGNED…………………………………….............DATE……………