Wufoo

Name * First Last
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Number *
Email *
Number of Entries (£5 each) *
Enter a number greater than or equal to 1.

The number of entries you wish to have in the draw. Each entry is £5 a month.
Entry Total * £ Pounds . Pence
The total amount you will be paying monthly, this is the number of entries you want, multiplied by £5. (e.g 2 entries = £10)
Once you have submitted your form you will be contacted by the club via email to pass you the standing order information for payment. By submitting this form you are committing to the above number of entries for at least one draw, this will be at the end of the month if submitted before the 20th or at the end of the next month if submitted after.
Do Not Fill This Out

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