Outwood  Working  Mens  Club
62 Ledger Lane,  Outwood,  Wakefield,  WF1 2NS    Tel: (01924) 824 156



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Membership Application Form

Current INITIAL Membership Fee: 10.50 (includes 3.00 one off payment for door entry fob)
C.I.U. Affiliate Card T.B.A.  C.I.U. Annual Year Card 3.50

Essential Information:

Name
E-Mail

Optional Information:

Address
Telephone
Fax
Mobile
Age  

Optional Comments and / or Requests for Further Information:
[Please Edit before Submitting this form........
......... you should then receive confirmation of your submission]

Please Press Submit Button ONCE and WAIT for CONFIRMATION

                            


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