CCLSC Application for Membership

Name

Address

Postcode

CCFC Supporter Number

Home telephone number

Mobile telephone number

Work telephone number

Email address

Names of additional family members

Select membership level required

Please send proof of eligibility with payment

I hereby declare that I will abide by the constitution of the Coventry City London Supporters Club

and I willl send within seven days a cheque/postal order made payable to CCLSC

Please tick to confirm acceptance

How did you hear about CCLSC ?

Returning member

From existing member (name)

Web search (using)

Other (please specify)

Where do you sit at the Ricoh ? (This is optional, but would help CCLSC to keep in touch,

distribute magazines on matchdays, etc)

Stand :

Block :

Row :

Seat :

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