Membership Form

Please complete the form below and send to the following address or bring along to the Supporters Trust Office or monthly meeting with the appropriate remittance

Send to:

Membership Secretary
c/o Barnsley FC
Grove Street
Barnsley S71 1ET

Name: ________________________________________

Date of Birth: ____________________________________

Address: _______________________________________

______________________________________________

_______________________ Postcode: ______________

Telephone Number: _____________________________

Mobile: _______________________________________

Email: ________________________________________

Membership type:  (please delete as appropriate) Adult / Junior / Over 60's / Disabled / Life

Payment Method: (please delete as appropriate)   Cash /Cheque/Debit Card/Credit Card

Payment amount £_______ .  For a limited period, we can accept multiple years payments.

Please indicate number of years membership required: _________

Please make cheques payable to "Barnsley FC Supporters Trust"

Credit Card / Debit Card Payments:

Credit Card type : Visa / Mastercard  / Visa Electron / Maestro / Solo

Name of card holder (as appears on card): __________________________

Card Number: __________________________________

Expiry Date: ______________

Start date: _______________

Issue Date: ______________ (debit cards only)

CVA2 number: ____________

Address of Cardholder: ________________________________

____________________________________________________

______________________________ Post Code: ____________