To: The Treasurer, UKCCOA

Daniel Kemble,
Flat 1,
Mallard Court,
Connaught Avenue,
Chingford,
London,
E4 7UE,
UK

I would like to order the items detailed below for the value as specified on www.uk-cherub.org at the time of printing
Item 1 __________________________________
Item 2 __________________________________
Item 3 __________________________________
Item 4 __________________________________
Item 5 __________________________________

Name      __________________________  Date      __________________________

Address   __________________________  

          __________________________  

          __________________________  

          __________________________  

Telephone __________________________  

Mobile No __________________________

Email     __________________________

I enclose a cheque made payable to "Cherub Class Owners Association (UK)" for £____ for the above.
I ackowledge that this form is an order for goods for which I must pay.
I understand that delivery of items may not be immediate.

Signed    __________________________