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Application form

Burslem Izaak Angling Society

New Members Application Form

 

 

Name

 

Address

 

 

 

 

 

Post Code

 

Telephone

 

Email

 

 

Membership Rates for  2019

Adult members: £39.00

 Seniors Over 65 years: £30.00

  Juniors: Under 18: £5.00 must be accompanied by a full paying adult

 

Valid from 1st January 2017 to 31st December 2019

                                                                           

 

 

                 Cheques and Postal Orders payable to BIWAS

 

           Please enclose a stamped addressed envelope

           Return to

           Neil Degg

           13 Churnet Road

           Forsbrook

           Staffordshire

           St11 9bp

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