| Name: |
________________________________________________ |
| Address: |
________________________________________________ |
| |
________________________________________________ |
| |
________________________________________________ |
| Postcode: |
________________________________________________ |
| Country: |
________________________________________________ |
| Telephone: |
________________________________________________ |
| Email
Address: |
_______________________________
(if applicable) |
| Home
Page: |
_______________________________
(if applicable) |
| Additional |
________________________________________________ |
| Members |
________________________________________________ |
To assist with future development of the club please feel free to complete the following
members profile* |
| Occupation: |
_______________________________________ |
| Date
of Birth: |
______/______/______(day/month/year) |
| Favourite
Type of Coaster: |
Wood
or Steel (circle as applicable) |
| Favourite
Wooden Coaster: |
_______________________________________ |
| Favourite
Steel Coaster: |
_______________________________________ |
| Favourite
Park: |
_______________________________________ |
| Amount
of different coasters ridden: |
_______________________________________ |
| Favourite
Non Coaster Ride: |
_______________________________________ |
| |
|
| How
did you get to hear about the Club? |
_______________________________________ |
| Occasionally we are asked by the media for members in different areas for
publicity. Would you like to be added to the publicity list? YES/NO. |
| *all information will be treated with the strictest of confidence and will
not be passed on to any third party. |
The
Roller Coaster Club of Great Britain
PO Box 235, Uxbridge, Middlesex UB10 0TF. |