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The Seaton & District Music Club. Registered Charity No 271521

Application Form
Season 2011/2012

Address	..........................................................................................................
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Telephone	..........................................................................................................

Please note that one Application Form can be used for one or two people at the same address.
Applications for larger numbers or more people at different addresses must be on separate forms.

Subscription:

Adults

..... @ £45.00 :

£........

If you pay Income Tax or Capital Gains Tax, you may like to allow the Club to re-claim tax on your subscription. Tick here if you want us to re-claim tax on your subscription [ ]

Please make cheques payable to: SeatonMusic.
and send this completed form with a 9"x6" stamped addressed envelope OR address label with stamp to the Subscriptions Secretary:
Geoff Sharpe, 17 Ryalls Court, Seaton, EX12 2HJ