100 Club Application Form

I/we apply for membership of the Chess Scotland 100 Club

and wish to purchase ____ units at £1 per unit over ____ months.

I/we agree to abide by rules as set by Chess Scotland.

 Name: ____________________________________________________

 Address: __________________________________________________

 __________________________________________________________

 Post Code: _____________

 Your Signature: _________________________________________

 

 Payment Enclosed: ______ (pounds - in multiples of 12) for ___ year(s)

 .... or

 Standing Order: I have sent a standing order to my bank ______ (tick)

 

Please post this form to:

Chess Scotland Treasurer, Mac McKenzie, 29 Coylton Road, Glasgow G43 2TA. (Tel: 0141-633-0663)