PLEASE USE BLOCK CAPITALS
Surname ..........................................................
First Name .................................................
Address..................................................................................................................................
................................................................................................................................................
...............................................................................................................................................
Phone Nos: Home ......................... Work .....................................Mobile:..............................
E-mail address: ........................................Fax: .........................................................
Signature:
...............................................Date: .....................................................
Amount enclosed:
EURO ....................................................
(Insurance cover commences when membership fee,
inclusive of premium, is paid) |