Name:

Address:

Post Code:

Telephone:

Email:

I wish to become a member of the Friends of Launceston Priory

Signed:

Dated:

I will pay annual fee of £2 by (Please tick one)

Cash

Cheque

Cash or cheque received

Date

Name of person receiving money

Signed as received

Please return the completed form to:

Friends of Launceston Priory
Jacki Ellis-Martin, Glenkeller Cottage, 10A Dutson Road, Launceston PL15 8DY