OLD WYCOMBIENSIANS’ CLUB

I would like to become a Life Member. Enclosed is a cheque for £30.00 payable to ‘Old Wycombiensians Club’.

Please complete your details below:

Surname:
First Name(s):
Address:
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.
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Post code:
Country (if abroad):
Dates attended RGS: From: To: 
Telephone: Home: Work: 
Fax: Email: 

Please return this form to:

Mr I R Clark

Honorary Secretary

Old Wycombiensians

5 Foxhill Close

High Wycombe

HP13 5BL

For Office Use:

Membership Number: