Title: ...................... First Name: .............................................. Surname:..............................................................................

Address: .................................................................................................................................................................................

................................................................................................................................................................................................

................................................................................................................................................................................................

Post Code: .....................................                                                        Date of Birth.............................................

Telephone Number: ...........................................................................

Experience:

For reference purposes, please give names, addresses and telephone numbers of two persons, (not related), who have known you for at least three years.  All information given is for the use

of the Talking Magazine only.


Name........................................................................                   Name..........................................................................

Address................................................................,...                   Address......................................................................

.................................................................................                    ..................................................................................

.................................................................................                    ..................................................................................

Tel:...........................................................................                    Tel:..........................................................................


Signature of Applicant.................................................                  Date: ........../........../...................
Thankyou for your interest.

Please send this application to: -                                                The Secretary

                                                                                                    Hull & District Talking Magazine

                                                                                                    25, Portland Street

                                                                                                    Hull,  HU2 8JX