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telfordharriersrc@gmail.com

Membership Form

Page Title

Est 1984

Membership Type (please select) *

Ordinary Membership (competitive) £35

Ordinary Membership (concessional/student/retired) £25

Second Claim £15

Social Member £15

Life Member £ n/a

Full Name

Date of Birth

Registered Gender at Birth (M or F)

Email

Address Line 1

Address Line 2

City

Post code

County

Phone

Emergency Contact Name

Emergency Contact Number

Relationship to applicant

Thanks for registering!

Our membership secretary will be in touch to complete the process

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