I wish to become a member of the Perry Barr RGT 50-50 Club and would like to hold____ unit(s) at £1 per unit per month.

Please send my winning cheque to:

Name_____________________________________________________

Address___________________________________________________

________________________________ Postcode__________________

Telephone number:_________________ Signed:__________________

Standing Order Form

To ___________________________________ Bank/Building Society

(please insert your Bank/Building Society name)

Address ___________________________________________________

(please insert your Bank/Building Society address)

Please pay Lloyds TSB Bank for the account of Perry Barr RGT 50-50 Club, Sort code 30 19 40, Account Number 00655609

the sum of £_____ pound(s) ( insert amount) commencing on the First

of ________________ (insert month) ___________ (insert year)

and continuing on the first of each month until further notice, debiting my

Account Number _____________________________

Please quote the remitter's name as reference to the beneficiary.

Name of Account Holder(s)_______________________________

Signature(s)___________________________________________

Send this form to 119 Queens Road Yardley Birmingham B26 2AS