The Official Leonard Nimoy Fan Club Membership Application form

OLNFC

22 PUREFOY ROAD

COVENTRY

CV3 5GL

ENGLAND

(DELETE WHICH IS NOT APPRECIABLE)                                   FULL MEMBERSHIP

                                                                      HALF MEMBERSHIP

                                                      RENEWAL

TITLE (Dr,Mr,Mrs,Ms etc)......................................................................................................

Surname / Family Name......................................................................................................

First Name / s.....................................................................................................................

Address..............................................................................................................................

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

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

Postcode/Zip......................................................................................................................

Country..............................................................................................................................

Telephone no......................................................................................................................

Email.................................................................................................................................

Payment:        ( UK= £12    USA= $25  REST OF WORLD INCLUDING EU=PayPal  )

        

PayPal (non UK).............Cash(UK only)...........P O (UK only)...... Cheque (UK only)..........

       

Amount Enclosed.................................Sent via Paypal...............................................

SOMETIMES WE ARE ASKED TO PROVIDE FANS FOR TV/FILM/PRESS

IF YOU WOULD BE WILLING FOR YOUR CONTACT DETAILS TO BE PASSED ON TICK HERE............

THERE IS NO OBLIGATION TO DO THIS AS A CONDITION OF MEMBERSHIP,AND WE WOULD ALWAYS CONTACT YOU FIRST,

BEFORE GIVING OUT ANY PERSONAL CONTACT  INFORMATION TO THE MEDIA.

IF YOU ARE NEW TO FANDOM AND  HAVE ANY QUESTIONS

JUST INCLUDE THEM ON THE BACK OF THE FORM

3. MAKE PAYMENT

 

   UK Residents : write cheque payable to OLNFC for the value of £12

                          - postal orders are accepted

  

   Non-UK resident: Make your payment using Paypal by following the link                                  below.

                              Or send cash in £ /USD at your own risk.

           Please note we no longer can accept Euros as cash payments please use paypal or send cash in USA Dollars or UK Sterling

THE  OFFICIAL LEONARD NIMOY FAN CLUB

MEMBERSHIP

APPLICATION FORM

There are 4 stages to complete for membership

1. READ THE INFORMATION PAGE

2. PRINT OR COPY THE FORM BELOW AND COMPLETE      DETAILS REQUIRED CLEARLY

4 SEND TO OLNFC

 

UK Residents:       Please mail completed form plus cheque (ensure you                                     sign,date and complete £12 payable to OLNFC )

Non UK Residents: If you sent money by Paypal please email us

                                      to tell us to expect your payment.

                            Then  send completed form to us.                          

                            If you choose to send us a cash payment in accepted                                     currencies please ensure the money is not visable though                              the envelope. Enclose with the complete form and send                                 to us.

                            (we do not recommend you register or record as this draws attention to                                     the fact something of value is inside)

                           

                            

                  THIS IS WHERE TO SEND THE COMPLETED FORM 

OLNFC

22 PUREFOY ROAD

COVENTRY

CV3 5GL

ENGLAND