Print out this form and send to Patricia Bayne, Pinewood Lodge,  Harts Lane, Bawburgh, Norwich NR9 3LT.

Name.......................................................................................................................................

Address....................................................................................................................................

............................................................................................Telephone....................................

I wish to apply for membership of the Bawburgh Village Hall 50/50 Club.

I should like my number(s) to be entered in the monthly draw and I should like to pay annually/quarterly/monthly.

Signature..................................................................................................................................

Date.............................................................

*Number(s) allocated..........................................

*Numbers will be allocated to new members and given with a receipt and a copy of the rules.