GOSPORT AND PORTSMOUTH

RANGERS SUPPORTERS CLUB

 

MEMBERSHIP/RENEWAL FORM

 

Name...................................................                        Contact Tel No ..................................

 

Address...............................................                        Date of Birth......................................

 

............................................................                        E-Mail................................................

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

 

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

 

New Member                Yes/No       Fee £12 Junior (Under 16) £6

 

Renewal                        Yes/No       Fee £10 Junior (Under 16) £5

 

(Existing Membership No.............................)

 

 

Signature.........................................................                                

 

Committee Signature.....................................

 

New Membership Number............................               Return to Club Secretary