Wilpshire Riding Club

Membership Form

2011

Please complete this application form, enclose cheque payable to WILPSHIRE RIDING CLUB and send with a stamped addressed A5 Envelope to: Mrs Marion Gregson, 107 Pleckgate Rd, Blackburn BB8 1QA

Full Name _______________________________________________________________________________

Address _________________________________________________________________________________

________________________________________________________________________________________

Post Code _________________ Telephone _____________________Email___________________________

Age at 01/01/11 ______________ Date of Birth _______________

Family Membership Only:- Please list the names of your family with D.O.B on the reverse of this form

I agree to abide by the rules of Wilpshire Riding Club as printed in the full schedule.

Signed __________________________  Date___________________

WRC Use _______________