MEMBERSHIP FORM

THE ROBERT JONES AND AGNES HUNT ORTHOPAEDIC HOSPITAL NHS FOUNDATION TRUST

OLD OSWESTRIANS' CLUB

I wish to become a member of the Old Oswestrians' Club and for information to be sent to me each year about Club meetings.

Name ........................................................................................................

Permanent Address :

Present Address:

Post Held :

Duration of employment at RJAH Orthopaedic Hospital, Oswestry:

Tel No:  

email address: 

Subscription:          LIFE MEMBERSHIP            £25.00

Cheques to be made payable to “The Old Oswestrians’ Club”

I enclose a cheque to the value of £25.00 British Sterling.

I have paid via BACS    IBAN: GB06HBUK 403532 90633135

SIGNED ..

DATE .

Return to:

 or email:   rjah.oldoswestriansclub@nhs.net