| The Membership Secretary |
| Brighouse Vintage Model Aircraft Club |
| 26 Bramley Lane |
| Lightcliffe |
| Halifax HX3 8SR |
| Name | ||||||||
| Address | ||||||||
| Phone Number (Home) (Work) | ||||||||
| e-mail address | ||||||||
| Birthday and age @ Last 1st January | ||||||||
| I am Affiliated to the BMFA via :- (Please enter your Home club name and its BMFA Number) | ||||||||
| My BMFA Membership Number (if applicable) | ||||||||
| Level of Achievement - None, A, B, I, or E | ||||||||
Fees Enclosed
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| Signed and Dated | ||||||||
| Please make any cheques payable to :- "Brighouse Vintage M.A.C." |