Please print off and complete one copy for each email application.
Your name:
Contact Address:
Requested email address - please write clearly:
| ........................................................... | @ lynehamvillage.com |
| ............................................................. | Your
Password please write it clearly |
Please sign below to confirm that you have
read and agree to the conditions.
If under 16 years of age, tick here (...) and then please ask parent/guardian
to sign below to confirm that they have read and agree on your behalf to the
conditions):
| Signed: | ..................................... |
| Name printed: | ..................................... |
| Date: | ..................................... |
Please attach a cheque for the correct amount
payable to A HUMM.
Post to:
Lyneham Village Online,
18 Sycamore Close
Lyneham
Chippenham
Wiltshire SN15 4TG.