Registered Charity

203644 (England and Wales)

SC037711 (Scotland)

100 Club Agreement 

Title   First Name   Surname 

Address       

Town     

County           Post Code 

        Telephone          E-mail    

I wish to have   number/s for each monthly draw

(Each number will cost you £2 per month)

Then select one of the following options and delete the other one.

 Signature                                                              Date                          .                                      

If paying by cheque these should be made payable to WORTHING CATS PROTECTION.

This form (together with a cheque or a copy of the standing order) should be sent to the address below.