NAME

DATE OF BIRTH

ADDRESS

CITY PROV.

POSTAL CODE

PHONE BUSINESS PHONE

E-MAIL

I AM INTERESTED IN PLAYING:

SNOOKER EIGHT-BALL NINE-BALL BILLIARDS OTHER

I WILL BE PAYING THE $10 MEMBERSHIP FEE BY MAIL

MAIL CHEQUE TO:

BC CUE SPORTS SOCIETY, 8013 - 136A Street, Surrey BC V3W 1M6