Three Percenters MCC Membership Application

Please complete this form and send it with your membership fee to

John Gillies
Membership Secretary
Flat 3
47 Queens Road
London SW19 8NP
*******************************************************

First Name(s):	______________________________________

Last Name:	______________________________________

User Name:	______________________________________

Email:		______________________________________

Address:	______________________________________

		______________________________________

		______________________________________

Postcode/Zip:	______________________________________

Country:	______________________________________

Date of Birth:	______________________________________

Sobriety Date:	______________________________________

Bike(s):	______________________________________


*******************************************************


Membership fees (in Sterling):
Sole UK				£12.00
Joint UK			£18.00
Overseas			£20.00

Cheques or postal orders should be made payable to Three Percenters MCC (no cash please).
Payment can also be made via PayPal using the Paypal account: threepercentersmcc@gmail.com.

International members please use our shop where you can pay with a credit card. You do not
need to have a PayPal account. High bank charges mean we cannot accept non-UK cheques or money orders.

By the way if money's a bit short at the moment, let us know and we'll make you a member anyway. 

Partners and friends who are not recovering alcoholics or addicts can also join as Associate members. The same membership fees apply.