Black & White Club Application Form

Please sign me up to the Black & White Club

Name…………………………………………….

Date of Birth ………………………….

Male……… Female ………….

Parent/Guardian’s full name……………………………………..

Address…………………………………………………………………………

……………………………………………………………………………………..

Postcode …………………

Email address…………………….......................

Favourite QP player……………………………………..

I give permission for ____________________'s photograph to be published on the official Queen's Park FC website or used for other QPFC promotional publications.

Parent Signature……………………………………..

Complete and send to:

Black & White Club
Queens Park Football Club
Hampden Park

Mount Florida

Glasgow G42 9BA

Tel 0141 632 1275

Alternatively, hand in completed Application forms to the Souvenir shop during any home match.