FAIR ORGAN PRESERVATION SOCIETY
                      MAIL ORDER FORM

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Postal address.....................................................

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...........................................Postcode...............
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                                                   Goods |        |
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                                                   +p&p  |        |
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Please send a cheque made payable to FOPS, or
    enter your card details below.
Cards accepted:
Delta, Electron, Fortoak, JCB, Maestro, Mastercard, Solo, Visa


Card number...................................................

Start date............. Expiry date............. Issue No......

Name and address of cardholder, if different from above:

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Cardholder's signature.........................................

Date...........................................................

Please post completed form to:
Mr A G Harrison, 61 South Parade,
OSSETT, WF5 0EF                             Tel. +44 (0)1924 272987