Name                

     Address       

                              

   Tel No                     

    Mobile No    

    I / We would like to become a patron/s.  

    Single Patronage   (£10.00 or more??!!)     

    Joint (2 people) Patronage  (£15.00 or more ??!!)      

On receipt our Patrons Secretary

will contact you.

Thank you for your support.