Storth Village Hall 160 Club MEMBERSHIP APPLICATION FORM
Registerd Charity No. 523079
The Promoter - Mr D Holdsworth
'Springbank', Storth Road, Storth, LA7 7JL (01524 761878)
Lottery Terms
I hereby wish to apply for membership of the Storth Village Hall 160 Club, and agree to pay the one off membership fee of 5p (a requirement of the Lottery Licence) together with the Annual Subscription of £13.00. I understand that three winners are drawn monthly every month, with a larger prize in December. I also agree to my email address below being added to the monthly newsletter from the Village Hall, in order to notify me of the winners.
Required Information - Please complete in full
All information in the following section marked with an asterisk (*) is required in order to submit this form. The "Submit" button will not work if these fields are incomplete!
Contact Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address Line 1
Address Line 2
Town/City
County
Post Code
Phone Number
*
-
Area Code
Phone Number
Terms and Conditions
*
Date
*
-
Month
-
Day
Year
Date
Signature
Should be Empty: