I would like to join the Leila Birch CyberFanClub

Contact Information

Name
Age (if under 18)  
Birthday  
Address
Telephone
FAX
E-mail

Tell us a bit about yourself - 

Membership fee £5    I wish to pay by  All proceeds go to Children's Charity

You may pay us by Credit Card - This is about as safe as giving your credit card number over the telephone. Your number will not be displayed - Please enter details below 

Type of Card    if switch issue number

Expiry Date of Card       month     year     

Your Credit Card Number

Number

Credit Card Name of holder

Name of holder

Address of card holder

Address of card holder 

If you do not have access to a credit card you may send a cheque or postal order made out to the 'Leila Birch Fan Club' and addressed to - 

Leila Birch

c/o McLean-Williams Management

Thames Wharf Studios

Rainville Road

London

W6 9HA

Please note that all receipts and correspondence will be by electronic mail only although your membership gift pack will be sent by surface mail postal services.

We reserve the right to alter the conditions and charges of membership from time to time and to refuse or terminate membership without explanation. Under sixteens should seek parental permission to join. Leila Birch and her associates accept no responsibility for any losses or inconvenience incurred by those wishing to join the fan club or being banned from membership.