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)