Please print this form off first and then complete it clearly and send it with your membership fee of £10 to the Membership Secretary at the address below.

Please make your cheque payable to "Birmingham Inter-Varsity Club Limited".

Prospective Membership gives you membership of the club for three months.

Please note that you have to be aged 18 plus to apply.

NAME ………………………………………………………………………………

ADDRESS …………………………………………………………………………..

……………………………………………………………………………………….

………………………………………………………………………………………..

POST CODE …………………………………………………………………………

TELEPHONE (HOME) ……………………………………………………………..

TELEPHONE (MOBILE) …………………………………………………………..

EMAIL ……………………………………………………………………………….

I agree to abide by the Club's code of conduct and hereby apply for Prospective Membership.

Signed ……………………..…………………Date …………………………………

Please post (with your cheque) to:

Peter Howe, Membership Secretary
Birmingham Inter-Varsity Club Limited
18 Deakin Road
Erdington
Birmingham
B24 9AN