WWWC
Carrington Street West Wallsend     ph. (02) 49 53 2920 fax. (02) 49 55 1024     PO Box 21 West Wallsend 2286
 
  Surname : Mr/Mrs/Ms/Miss
  Other Names :
   
  Address :
  Post Code :
   
 
I do herby consent to be nominated for membership of the West Wallsend Workers Club Ltd. and I agree to be bound by the Memorandum and Articles of Association, by-laws and/or alterations thereto, if my nomination is accepted by the Board of Directors.
  Signature Of Applicant :
 		  Date :
   
  Signature Of Nominator :
  Membership Number :
   
  Signature Of Seconder :
  Membership Number :
   
             
Office Use Only
 		Birth Date Verified :
  Fee Paid Rec. Number :
  Membership Number :