Please print this form and send or fax to the above address
  

DATE

NAME

MEMBERSHIP NUMBER

ADDRESS

POSTCODE

DAYTIME TELEPHONE

SIZE

COLOUR

DESCRIPTION

QTY

PRICE

TOTAL

Please allow for postage and packing

TOTAL

Delivery address if different from above

NAME

ADDRESS

I enclose my cheque made payable to Leander Club OR

My credit card details are: