APPLICATION FORM

Print this form and complete.

I wish to join Baseline and enclose:

For UK Members - my cheque/postal order for £15 (UK postage)

For overseas members - my payment for (delete as applicable):

£20 (Europe airmail rate)
£30 (Other overseas airmail rate)

Overseas payment acceptable in £ STERLING only. This may be a sterling Draft, drawn on a UK bank or Eurocheque made payable to "Baseline".

Please send to:

Baseline
227 Henley Road
Caversham
READING,
BERKSHIRE RG4 6LJ
United Kingdom

PLEASE PRINT CLEARLY
First Name/s		Second Name
Address

			Zip/Postcode
Country
Questionnaire - optional please tick/complete boxes as appropriate
Age	Upto 15	16 - 25	Over 25
Sex	Male	Female
Tennis Player	Yes	No
Have you watched Andre play live?	Yes	No
If Yes, please give details: Country/s Tournament/s Year/s
How long have you been a fan of Andre?
Do you receive satelite TV?	Yes	No
Where did you hear of Baseline?	www.andreagassi.co.uk
For Office use only
Issue No.	Payment	Date despatched