(This is a text file which should be available for use with a very wide range of computer software 
packages.  Please also return it to us as a text file if you send it by email.)


Club Amphora Application Form


Please enter your details below and email as an attachment to AmphoraUK@aol.com or print it out 
and fax it to 01403 791977.  By doing so, you are asking to receive the benefits offered by Club 
Amphora, as described on the website www.amphorawines.co.uk.  Thank you so much.


Your Title (eg Mr, Mrs, Ms, Dr, Prof):


Your first name:


Yours last or family name:


Your Address (residence number or name, street, area/district/village, postal town, post code):






Your telephone number(s) (to be used to arrange deliveries to you):




Your email address (so that we can send you our Club Amphora newsletter):