Name

Address

Town

Postcode

Home Phone

Mobile Phone

Email Address

Season Card No

City Card No

Status

ADULT

JUNIOR

(d.o.b.)

SENIOR (OAP)

(d.o.b.)

I wish to apply for membership to the Manchester City F.C. Supporters' Club (1949) as a member

of

branch.

 If elected I agree to pay the membership fee

Signed

of £10.00 and abide by the rules of the club.

Date

Fees received

Mem. No.