SURNAME:
FORENAMES:


ADDRESS:...................................................................................................................

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POSTCODE:
TELEPHONE NUMBER:
MEMBERSHIP FEE £20 per HOUSEHOLD
ENCLOSED £20 TO COVER.........................PERSONS
CHEQUES PAYABLE TO DORSET KOI KEEPERS (IN FULL)

I AM OVER 16 YEARS OLD AND AGREE TO ABIDE BY THE RULES OF THE CLUB.

I HEREBY GIVE PERMISSION FOR D.K.K. TO HOLD MY NAME, ADDRESS & PHONE NUMBER ON COMPUTER FOR THE SOLE PURPOSE OF MEMBERSHIP RECORDS AND MAGAZINE MAILING. THIS INFORMATION WILL NOT BE DIVULGED TO ANY THIRD PARTY.

SIGNED.......................................................DATE........................