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Application Form
Please print this page and send to the promoter by post.
Member's details:
| Full name | _______________________________________ |
| Address | _______________________________________ |
| _______________________________________ | |
| _______________________________________ | |
| _______________________________________ | |
| Postcode | _______________________________________ |
| Phone number | _______________________________________ |
| _______________________________________ | |
| Home tower | _______________________________________ |
Selection details:
| Number of shares: | ________ |
| Amount due (£10 per share) | £ ________ |
Signature _______________________ |
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Please do not send cash through the post. Cheques should be made payable
to "KCACR Cant Dist 120 Club".
If you would like to choose your number(s) please ring me on 01227 455659 or e-mail me
Check if the number you want is still available by looking on
The list of numbers
Please send this form with payment to:
Mr B Reynolds
Hon Promoter, Canterbury District 120 Club
11
Bramley Avenue
CANTERBURY
CT1 3XW