REPTA “JOIN NOW” ORDER FORM
New Member or Renewal (delete as applicable)
Full Name(s):
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Full Address:
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Post Code: |
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Date(s) of Birth:
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Telephone Number: |
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Email Address:
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Please indicate if you wish to take advantage of AVIVA / REPTA (16 to 79 years) Limited Personal Accident Cover at no extra charge YES / NO (circle preference). |
Total remittance enclosed: |
£................................... |
MEMBERSHIP FEES: £3.75 per annum including post & packing, and £2.50 for each
additional card to the same address.
(Please make payment by Cheque or Postal Order payable to REPTA).
POST TO:
Mr Colin Rolle,
Correspondence Secretary,
REPTA,
4 Brackmills Close
Forest Town
Mansfield
Notts. NG19 0PB.