TO JOIN - Complete this form and return to:
Stuart Heaps, 10 Christines Crescent, Burscough, Lancs  L40 7SJ
Tel: 01704-894518

I would like to become a member of the BURSCOUGH FC GOLD BOND Weekly Draw (I am over 16 years of age)

NAME:  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
ADDRESS: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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POST-CODE:  . . . . . . . . . . . . . . . . .

Tel: . . . . . . . . . . . . . . . . . . . . . . . . . .

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