Registration Form for BCGBA Membership  
   
  County Association: BRITISH PARKS CGBA County Membership Number: BCG 10021 PA  
                     
  Club Name:   Club Membership Number:        
   
   
  Number ~ Mr/ Mrs/Miss /Ms First Name Name 2 Surname Gender M/F Date of Birth  
                     
  ~ Applications for a Replacement Card only  
   
  Address Post Code Email Tel: Landline   Tel: Mobile  
               
   
  Ethnic Origin * Disability or Serious Illness *  
       
  * Please see notes for further information on these two boxes  
   
  Card to be returned to: Club Secretary   Please tick your  
  Applicant   preferred option  
   
  I enclose a cheque to the value of (10 for a new player, 3 for a replacement card)  
   
  Cheque to be made payable to: B.P.C.G.B.A    
   
  Send to County Registrar:RAYMOND LORIMER  
  Address:170 WHITELEES ROAD, LITTLEBOROUGH, LANCASHIRE, OL15 8DU  
  Phone:07742501392 E-mail: rayjlorimer@aol.com  
   
  If you wish to make an electronic payment please contact the County Registrar.  
   
  Please note: The information given on this membership registration form will only be used in connection with your BCGBA Membership and will not be shared with any other organisation.