Oldland Mill Trust "100" Club

Please complete this form and send it with your cheque payable to OLDLAND MILL TRUST to: Steve Berry, 1 The Quadrant, Hassocks, BN6 8BP I wish to join the draw with _____entries at £12 each per year Total Payment £_____ (Reduce by £1 for each draw missed.) Title: MR / MRS / MISS / MS / OTHER______________________ Name (in capitals please) ____________________________ Address____________________________________________ ___________________________________________________ Postcode ______________ Telephone___________________ email:________________________________________________ I understand that draws will be on the first Thursday of each month. Signed_________________________________Date__________