The

 Official Keith Scott Fan Club

Application Form

(Please use block capitals)

NAME...............................................................................................................

ADDRESS........................................................................................................

..................................................................................................... ....................

.........................................................................................................................

E-MAIL ADDRESS...........................................................................................

DATE OF BIRTH..................................

SUBSCRIPTIONS

UK.............................................£10.00 (UK CURRENCY) 3 ISSUES

EUROPE....................................£15.00 (UK CURRENCY) 4 ISSUES

REST OF WORLD.....................£15.00 (UK CURRENCY) 3 ISSUES

NOTE: If you would prefer to pay in your own currency please e-mail for details BEFORE sending your payment (as the relevant exchange rate will need to be calculated)

IF SENDING PAYMENT IN CASH PLEASE REGISTER YOUR ENVELOPE SO THAT YOU
WILL HAVE PROOF THAT YOUR MONEY HAS BEEN RECEIVED

OVERSEAS PLEASE NOTE

UK CURRENCY OR INTERNATIONAL MONEY ORDERS MADE PAYABLE TO C. EVANS ACCEPTED ONLY

Please send subscriptions to:-

C. EVANS

THE KEITH SCOTT FAN CLUB

11 VICTORIA BUILDINGS,

COYTRAHEN,

Nr. BRIDGEND, MID, GLAMORGAN,

S. WALES, CF32 OEA. UK