HARWELL LABORATORIES RECREATIONAL ASSOCIATION
To: HLRA, The Pavilion, Rutherford Avenue, HSIC, Didcot, OX11 0DF
I wish to apply for: ORDINARY MEMBERSHIP (Summer Only)
I enclose cheque (payable to HLRA)/cash* to the value of £18 as my subscription for the Summer Season ending 31/08/2010
SURNAME (Prof/Mr/Mrs/Miss/Ms/Dr)*____________________________________________
Forenames:_______________________________ (Block capitals please)
Employer:______________________ Building:_________Tel:____________________ e-mail:______________________________
Home address:___________________________________________________________________________
______________________________________________________________________________________
Date:_______________ Signed:________________________________________
SPONSORSHIP (for contract employees on Harwell Campus only)
I certify that the above named person is employed at HARWELL/RAL/NRPB/MRC (*)
By:______________________________ (State Employer)
From:__________________ Until:_________________
Signature:______________________________ Name:_______________________ Date:________________________
* delete as appropriate
For Office Use Only:
Card No:_________ Issue date:______________ Signed:___________________ (Administrator)