Liskerrett Community Centre  -individual Membership application.

     Please print this form, fill in then information, (please print) 
      and return to Reception at the Centre.

 

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

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

     ..........................................................

     Post Code .........................

     Telephone
              Home ............................................

              Mobile........................................... 

     E-mail ...................................................  



     Can you give time to help in the Centre? .................

     What things do you like doing? ...........................




     I agree to abide by the rules of the Liskerrett Community Centre.



     Signed..................................... Date ..........                                       

For office use:        No.            Card            Register