APPLICATION FOR MEMBERSHIP / RENEWAL OF MEMBERSHIP:

Friends of the Church of the Blessed Virgin Mary & St. Leodegarius

I enclose a CHEQUE (£5.00 single or £10 family subscription)

amount £

membership

join

renew

title

name

address

post code

signed

date

COMPLETE & PRINT out this form, sign and date it
then send together with your cheque to:
Miss D E Godden
194 Milton Street North
Northampton NN2 7DD

Thank you for your support