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First Name*:
Family Name*:
Address 1*:
Address 2:
Town*:
Post Code*:
E-mail*:
Telephone*:
	You will receive confirmation of the court code and your identity tag on receipt of payment. Cheques, payable please to 'Friends of Boston Manor', to be sent to FOBM, c/o 5 Burnham Way, London, W13 9YD or deliver by hand to The Pavilion Cafe (opposite children's play area) Boston Manor Park. The Cafe is open 10 a.m. to 4 p.m. Saturday and Sunday. (Membership quoted includes FOBM annual subscription)
Member Type*:	Pull down to select Adult £27.00 Junior £12.00 Family £54.00 Adult Late/Part Annual £15
	If you have selected 'family' membership, please enter the full names of each family member in the boxes below (excluding the applicant's name already entered in the box above)
Name Family Member2:
Name Family Member3:
Name Family Member4:
Name Family Member5:
	Please enter any constructive comments, suggestions or requests you wish to make in the box below about the website, about the membership form or any other relevant item.
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