Valley Gold Membership Form New4 (PDF)

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Title: A5 Flyer

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A5 Valley Gold_back 2013_A5 Flyer 05/02/2013 11:31
1 Gold’s principal aim is to provide financial support to the Charlton Athletic academy in developing talented young footballers

Valley Gold membership form
This section must be completed by all new members.
I wish to join Charlton Club Valley Gold, and note that my number will not be in the draw until receipt of the first
Full name:

Title: Mr/Mrs/Miss/Ms/other (please state)

Membership number: CON
Home telephone:

Date of birth:

Mobile telephone:

Email address:

How did you hear about Valley Gold?
How much do you want to pay? (tick box)
£10 per month
£30 per quarter

£60 per half-year

£120 per annum

How do you want to pay?
Please decide which method you would like to pay by and complete the relevant section below.
1. Standing order
To the manager
Address (your bank address):

Account name:
Account number:
Sort code:


Until further notice

At the request of your account holder listed above, please make payment to: National Westminster Bank Limited,
Holborn Hall. Sort code: 60-40-04. For the credit of: Charlton Club Valley Gold (0274 9025)
2. Bank transfer If you use internet banking, this is the easiest and quickest way to set up your payments. Contact Sharron Sherress for more information or telephone her on 0208 244 7771.

3. Cash or cheque
Cheques should be made payable to Charlton Club Valley Gold. Please send remittance to Sharron Sherress, Charlton Club Valley Gold, The Valley, Floyd Road, London SE7 8BL

For official use only
Valley Gold membership number:
Date of database set-up:
Date of first payment:
Method of payment and amount:
Your comments will make a difference.


Valley Gold membership number:
The information you give us will only be used for the purposes of improvement.
Charlton Club may occasionally pass your details on to Charlton Athletic Football Club and its business partners, or the business partners of Charlton Club, for
marketing purposes. If you do not wish to receive details of promotions and offers from them, please tick the box(es) below.
I do not wish to receive details of offers and promotions from Charlton Athletic Football Club
I do not wish to receive details of offers and promotions from the business partners of Charlton Club
I do not wish to receive details of offers and promotions from the business partners of Charlton Athletic Football

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