Registration Form, please print this page and  return to Registrar; President Derek Rolinson

a: 4 hanging stones lane   old bank   ripponden   HX6 4HR

t: 01422 823129  e: darolinson@hotmail.com

Postal Address                                                                        Email:

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            Surname                            First Name               Rotary Club                                                                 District                                                                                                                                                                            

Please attach an extra sheet if more than six tickets are required.