If you are a member of the Belrose Bowling Club and would like to register as a member of
the Belrose Country Music Club, please complete this form and return to a committee member.

Please note:  Performers must be members of Belrose Country Music Club to be eligible for any sponsorship.

            (Please use block letters)

            NAME: ...............................................................................................................................................

            ADDRESS: ........................................................................................................................................

            ..............................................................................................................................................................

            PHONE: ..............................................................................................................................................

            EMAIL: ...............................................................................................................................................

[  ] NAME BADGE (optional): To order a BCMC name badge, tick this section and give the form,
together with your payment of $9.00 to a committee member