<![if supportMisalignedColumns]><![endif]>

      <![if !vml]><![endif]>
          <![if !vml]><![endif]>
      Registration Form for BCGBA Membership    
      County Association: Lancashire County Membership Number: LAN 12820 LG    
      Club Name:   Club Membership Number:          
    Number  ~ Mr/ Mrs/Miss /Ms First Name Name 2  Surname  Gender M/F Date of Birth  
    ~ Applications for a Replacement Card only        
    Please give reason for requesting a replacement card:            
    (eg card lost, card damaged, change of name)        
    Address Post Code Email Tel: Landline   Tel: Mobile  
    Ethnic Origin * Disability or Serious Illness #  
    * This is required to show that the sport welcomes all ethnicities # This is to assist the sport in supporting members with any individual needs
    - it would be appreciated if you could complete the above box - if no assistance is required please leave the above box blank    
    Card to be returned to: Applicant   Please tick your        
        Club Secretary   preferred option      
    - If you have selected Club Secretary then please give their name and full address below        
    I enclose a cheque to the value of £ _____________________________(£12 for a new player, £4 for a replacement card)    
    Cheque made payable to Lancashire County Crown Green Bowling Association     
    Send to County Registrar; J Glover  
    Address; :     21 Warwick Road. Atherton. Manchester. M46 9PL  
    Phone; 01942879385.        Mob- 07442166251              Email; Jimmy. glover@talktalk.net  
    Data Consent:  I understand that the information given on this membership registration form will only be used in connection with my BCGBA Membership and that the BCGBA need to collect membership data which will only be used for the promotion and marketing of the Asociation and affiliated bodies.  
    Print Name:  _______________________________________ Signed:  _____________________________________________________ Dated:  _________________________