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Date: 01/01/04
Group: Black Country Society Programme
Leader:
Venue Booking Form
Info: The Black Country Society - Members only (for insurance purposes)

Name ______________________________

Address __________________________________

__________________________________

__________________________________

Tel. Number ______________________________

(Indicate day, date, venue, places, cost)

Cheque total £__________ payable to Black Country Society

(price includes items where stated in individual programmes)

Please Note

Any directions will be issued with receipt/confirmation, non-smoking coaches have been booked.

Indicate preference of pick-up point:
Savacentre Oldbury
Dudley
BCS membership number _________

Remember - one cheque for Summer Programme Bookings. DO remember to enclose a SAE...if you want a reply. Do not include any subscriptions/fees with Summer Programme bookings

Please post completed form, cheque and SAE to:

The Black Country Society, Summer Programme, PO Box 71, Kingswinford DY6 9YN

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