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, David Congalton, 12F Townhead, Irvine, Ayrshire, KA12 0BE (Tel:01294 273114)