MANCHESTER CIRCLE OF mAGICIANS
MEMBERSHIP APPLICATION FORM
FULL
NAME
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STAGE
NAME (If Applicable)
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ADDRESS
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POST CODE ............................... ............................................................................................
PHONE
NUMBER.......................................................................................................
FAX
NUMBER........................... .............................................................................................
E-MAIL
ADDRESS ............... ............................................................................................
CREDIT
CARD DETAILS:-
CARD NUMBER
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NAME ON CARD ................. ..........................................................................................
EXPIRY
DATE ............................................Last three figures of security code
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ADDRESS OF CARD HOLDER IF DIFFERENT FROM
ABOVE
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All memberships are due for renewal from the
1st. January 2010
The membership fee for 2010 has increased to £15.00 per year.
Please make all cheques payable to Manchester Circle of Magicians. Credit Card renewals can ONLY be
accepted for amounts of £30.00 or over.
This form MUST BE COMPLETED IN FULL for renewals of membership.
Send
this form to:- Derek Lever, 32, Pilling Lane, Preesall, Poulton-Le-Fylde, Lanes. FY 6 0 EU
All enquiries to:- Derek Lever Phone or Fax: 01253 810113
E.Mail: d.lever1@sky.com
Website: www.taurusmagic.net
TELL ALL YOUR FRIENDS ABOUT THE MANCHESTER CIRCLE OF
MAGICIANS