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)

(Note: the first draw will be February 2006 so please ensure the date you have entered above is no sooner than February 2006)

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