BROOKSIDE ANGLING CLUB

 

MEMBERSHIP FORM 2018- 2019

 

MEMBERS DETAILS

 

FIRST NAME__________________________________ SURNAME_________________________________________

 

ADDRESS_______________________________________________________________________________________

 

TOWN________________________________________ COUNTY___________________________________________

 

POSTCODE___________________________________ D.O.B._____________________________________________

 

PHONE NUMBER______________________________ MOBILE____________________________________________

 

EMAIL ADDRESS_________________________________________________________________________________

Please tick if you wish to receive your monthly newsletter via email:

FAMILY / COUPLE MEMBERSHIPS ONLY

Fill in address and telephone details if different from details given above. Family membership consists of 2 adults & 2 children under 16 years old. Membership for additional children under the age of 16 years old is 2 per child

 

NAME 2_______________________________________________ ADDRESS___________________________________________________

 

D.O.B________________________________________________ PHONE______________________________________________________ _____________________________________________________

 

NAME 3_______________________________________________ ADDRESS___________________________________________________

 

D.O.B________________________________________________ PHONE______________________________________________________   _____________________________________________________

 

NAME 4_______________________________________________ ADDRESS___________________________________________________

 

D.O.B________________________________________________ PHONE______________________________________________ ___________________________________

 

TYPE OF MEMBERSHIP

Please circle the Price of the type of membership you are applying for below

                                                                                                                                         

                             SENIOR           JUNIOR               O.A.P                 DISABLED            FAMILY

 

NEW:                     40                20               22.50p              22.50          55

*RENEWAL/:        30                15                  20                     20             43

*ASSOCIATED

*Delete as appropriate

SIGNATURE - DATE JOINED

I/we understand that by signing this form that i/we agree to the constitution and all the rules of the club and I/we understand that if this application is accepted, if i/we break any of the club rules, then i/we could have my/our membership revoked, without financial refund.

Please provide 2 photographs for each person named on membership form.

 

MEMBERS SIGNATURE____________________________________ DATE______________

 

 

Processed by:__________________________ Treasurer Signature: _____________________

 

Licence No:____________________________ Members Number:_______________________