I wish to join the Yeovil Town Independent Supporters Association. I enclose my membership fee of £5.00.

My name:

Date of Birth (Under 16's Only):

My address:

Postcode

Telephone Number

E-mail address

My Signature:

Date:

NOTE: The information above will not be divulged to Third Parties without prior consent of the member.

(This following section to be completed by a Committee Member)

Amount Paid:

Membership Start Date:

Membership No.

E-mail Address Logged

Address Label Completed

Please return the completed form to any committee member along with your remittance, or post the completed form with remittance to:

YTISA
167, Plantagenet Chase,
Yeovil,
Somerset,
BA20 2PY.