Trust Membership Form

Any issues concerning the Trust please feel free to contact us at Airdrie United Supporters Society,

P.O Box 26423 or through The Broomfield Stomp web sites at www.sportnetwork.net/main/s2.php.

Please complete only one form per person, Additional application forms can be obtained from the Trust's

office or Website.

_________________________________________________________________________________

GENERAL DETAILS ABOUT YOURSELF

Surname____________First Name  _______________Mr/Mrs/Ms/Other__

Address__________________________________Postcode____________

Contact Telephone Number:________________________

E-mail address:________________________________________________

Are you willing to receive updates from the Airdrie United Supporters Society if yes please select whether by post [  ] or by E-Mail [  ]______________________________________________________

MEMBERSHIP OF TRUST (Adult Members 16 years and over.)

I wish to become a member of  Airdrie United Supporters Society, in accordance with its rules and I enclose

the £5 fee. Membership is re-new able on the 2nd of June 2004 and on the same date every year.

Signed ___________________________________Date _______________ _____________________________________________________________________________

MEMBERSHIP OF JUNIOR TRUST (Under 16 as of the 2nd of June 2003)

I wish to become a Junior member of  Airdrie United Supporters Society, in accordance with its rules and I

enclose the £1 fee. Membership is re-new able on the 2nd of June 2004 and on the same date every year. I

understand that I must get my parent or guardian to sign this application .

Signed _________________________________Date ____________

Signed Parent/Guardian ____________________Date____________ _____________________________________________________________________________

DONATIONS

Personal

I would like to make a personal donation to the Airdrie United Supporters Society, the donation of  £       is

 enclosed. I agree/do not agree to allow my name to be used in publications used by the Trust

Company

On behalf of ___________________________________________, we would like to donate the sum of £_______ We agree/do not agree to allow Airdrie United Supporters Society to publish our company name

 and details on publications and authorise the use of a link to our web site being used on line

Company name__________________________________________

Address_______________________________________________________

Telephone Number:____________________Web Site address:__________________________

Signed_______________________________Date:_________________

______________________________________________________________________________

TOTAL

Please return this application form to Airdrie United Supporters Society P.O.Box????.

Please find enclosed a cheque/postal order made out to Airdrie United Supporters Society for the

value of £             

Signed ____________________________________Date____________

_____________________________________________________________________________

TRUST USE ONLY

Date application received:

Membership Number

Membership card sent to applicant Date.