LloydsTSB Retirement Club, Birmingham
 
Membership
 
Please provide the following details:
 
Full Name:_________________________________________________
 
Postal Address:____________________________________________
 
__________________________________________________________
 
Phone Number(s):__________________________________________
 
__________________________________________________________
 
Email address:_____________________________________________
 
Joint Membership
Full Name:_________________________________________________
 
Former Employer (tick all that apply):
 
BMB____________ TSB___________LTSB____________
 
 
I agree to pay the Annual Subscription of 10 (Ten Pounds)
and enclose a Standing Order form
 
 
___________________________________________
(Signature)
 
______________________________
(Date)
 
Please return this form to:
David Parkes, 5 Hollywell Road, Knowle, Solihull, B93 9JY