ST GEORGE’S LAKE - APPLICATION FORM SEASON 2010/2011
(Please Print, Complete and Return)

Name: .......................................................................................................

Address: ...................................................................................................

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Contact No.: ..............................................................................................

Email: .......................................................................................................

Please enclose a passport size photograph with your application and return to the above address, together with a cheque for the appropriate amount (made payable to Still Water Leisure). Please also enclose a STAMPED ADDRESSED ENVELOPE.

Adult Membership £300.00

Junior Membership £150.00 (Up to 16 years of age)

By signing this application form I, the above named, agree to abide by the rules as set out in the Rules and Regulations of which I have read a copy.

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Signed

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Dated