Membership Form 2011-12

This form should be used for City Fans United Membership only. Junior Blues have a seperate form.

To join, please fill out the details below. Please note that all memberships expire on 30th June, 2012.

To make a donation on top of your membership fee, please enter your total contribution in the area below. If you do not wish to make a donation at this time, please select the total which corresponds to your membership type.

Currently we can only accept online payment by Paypal. If you wish to pay by any alternative method, please tick the box to send payment seperately. We would encourage those who have online or telephone banking to use this method of payment in preference to Paypal as this will avoid Paypal fees. You can, of course, send a cheque.

New Membership

	Adult (contribute at least £ 5.00 to be eligible for this membership) Adult Membership
	(Your initial membership fee will be processed once you complete the confirmation step. You will be able to cancel automatic renewals at any time by logging in to your account or contacting us.)

Other Amount

I will send payment seperately (tick box if NOT paying by Paypal).

Email Address *

Member Details

Title *

First Name *

Middle Name

Surname *

Date of Birth *

(clear)

Address Line 1 *

Address Line 2

Address Line 3

Post Town *

County

Country *

Post Code

Home Phone

Mobile Phone

Referrals

If you have been encouraged to join City Fans United by another member, please enter their details below.

Membership Number

Name

Thankyou for joining.