Membership form

      Be a part of the official disabled fan group

Annual Membership 5 per person
Family Membership 10  (2 adults & 2 children)






















For more details contact
Secretary Keeley Longdon 07850 428650 or @keeley32@btopenworld.com
Chairman Chris White         01142 465547 or @ wharfedalewhite@aol.com

Please Return postal completed forms to
57 Goodwin Road
Rockingham
Rotherham
S61 4DF














Name
Address
City
Postcode
Phone no
Email
Date joined
Family
Individuel