Title (Mr/Mrs/Miss/Ms etc) 		

	First Name(s): 		

	Surname: 	

	Address:

			

	Postcode 		

	Phone No.	

	e-mail address	

	Date of Birth 	  (if under 19) 

	Please give  brief  details of experience or membership of other 

	Cricket Clubs  (we don't mind if it's 'none')
			

	Type of membership  (2006 subscription rates shown) 	
	Senior Playing (£70)	Junior Playing (£5)	Student (£25)

	Non-Playing (£10)	Family (£15)

	Parent's Name (for under-18s) 

I declare that the above details are correct and that if elected to

membership I agree to abide by the rules and regulations of

Princes Risborough Cricket club.

	Signature:		

    Parent's Signature:	
	 (for under-18s)