(please print this form and complete in ink by hand)
My Club would like to consider participating in 'Jack in the Box' game and competition in the UK.

Please send me additional information about running an event.

Club Secretary's Name: __________________________________________________________

Name and Address of Club: __________________________________________________________

__________________________________________________________

Tel:_______________________________

* __ Please tick if your are in contact with a local RNIB fundraiser

* YES I would like an additional information set in
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    • large print
    • braille
    • tape

Please send this form to:
'Jack in the Box Co-ordinator,
Royal National Institute for the Blind
224 Great Portland Street
London WIN 6AA
Telephone 0171-388 1266
Centra1 Fax 0171-388 2034

Chairman John A Wall CBE
Director General Professor lan Bruce BSocSc CIMgt
Incorporated by Royal Charter.
Registered charity no 226227
VAT Registered no 524 4558 45