MANCHESTER CIRCLE OF mAGICIANS

MEMBERSHIP RENEWAL FORM

FULL NAME ...............................................................................................................................

STAGE NAME (If Applicable) .................................................................................

ADDRESS .........................................................................................................................................................................................

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POST CODE ............................... ............................................................................................

PHONE NUMBER.......................................................................................................

FAX NUMBER........................... .............................................................................................

E-MAIL ADDRESS ............... ............................................................................................

CREDIT CARD DETAILS:-

CARD NUMBER ..........................................................................................................
NAME ON CARD ................. ..........................................................................................

EXPIRY DATE ............................................Last three figures of security code .............

ADDRESS OF CARD HOLDER IF DIFFERENT FROM ABOVE

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All memberships are due for renewal from the 1^st. 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