Basildon & District Angling Society PO BOX 40 , BASILDON ...
Basildon & District Angling Society PO BOX 40, BASILDON, ESSEX. SS14 2ALASSOCIATE MEMBERSHIP APPLICATION FORM 2019(2018 MEMBERSHIP RUNS OUT 30/04/19) NOTE:- ASSOCIATE MEMBERSHIP ENTITLES USE OF ALL B.D.A.S. FACILITIES. IT DOES NOT ENTITLE YOU TO VOTE AT GENERAL MEETINGS OR A.G.M.s . SENIOR ASSOCIATE MEMBERS CAN VOTE ON THE CHOICE OF AWAY VENUES. ASSOCIATES CAN APPLY FOR FULL MEMBERSHIP AFTER TWO YEARS, BUT THE COMMITTEE WILL TAKE INTO CONSIDERATION THE MEMBERS COMMITMENT TO THE CLUB,WORK PARTIES ATTENDED , AND ANY DISCIPLINARY ACTION TAKEN AGAINST THE APPLICANT. SURNAME ___________________________ FORENAMES________________________________ DATE OF BIRTH----/----/----- OCCUPATION ---------------------------------- PHONE No______________________ ADDRESS_____________________________________________________________________________________ POST CODE_______________ 495300050800060293251460500PLEASE TICK TYPE OF MEMBERSHIP REQUIRED Please tick box New Member Renewal ….. SENIOR ?50.00 ….. JUNIOR (under 16 on 1 May 2019)……… ?35.00 ….. SENIOR CITIZEN ie. men over 65 and ?35.00 women over 60 on the 1st May 2019 ….. DISABLED …………… ?35.00 PLEASE SEND PHOTO COPY OF GREEN CARD OR SIMILAR DOCUMENT ….. FAMILY The ?80.00 covers the cost of the ?80.00 Name_______________Relationship____ AGE__ Partner & Spouse or 1 parent and 1 junior Name_______________Relationship____ AGE__ Each additional junior ?5.00 Name_______________Relationship_____AGE__ NOTE:- ONLY ONE KEY SUPPLIED WITH FAMILY MEMBERSHIP. EXTRA KEYS ?5.00 EACH. EMERGENCY PHONE No______________________ Where parents or guardians can be contacted ………………..PLEASE ENCLOSE :- 2 current passport photos with name on back, for each member cheque/ postal order payable to B.D.A.S. stamped addressed envelope (size 9 1/2 x 6 1/2) From time to time we need to carryout emergency work to our waters. Please indicate here if you would be available to help out. 5181600273050060579002730500434340027305003429000273050024003002730500457200273050013716002730500 MonTues TuesWedThursF Fri Sat SunPhone no if different to above………………… Email address ………………………….. (if you are happy to receive next year’s renewal form by e mail)THE INFORMATION CONTAINED ON THIS APPLICATION FORM WILL BE STORED ON COMPUTER , ACCEPTANCE OF THIS IS A CONDITION OF MEMBERSHIP. ENTRY ON OR USE OF THE FACILITIES AND PREMISES OF B.D.A.S. WILL BE AT THE USERS OWN RISK. B.D.A.S ACCEPTS NO LIABILITY FOR LOSS OR INJURY OF ANY KIND EXCEPT WHERE IT IS DUE TO THE NEGLIGENCE OF B.D.A.S. ITS SERVANTS OR AGENTS.. YOUR NAME MAY BE ENTERED ON A MAILING LIST. IF YOU DO NOT WISH TO RECEIVE OFFERS RELATED TO OUR SPORT OR GROUP DISCOUNTS OBTAINED PLEASE WRITE NO HERE …………………… 194310053975PHOTO 2ndMEMBERNAME………………………..Please sign back of photoAs acceptance of BDAS RulesSign………………………00PHOTO 2ndMEMBERNAME………………………..Please sign back of photoAs acceptance of BDAS RulesSign………………………22860053975PHOTO 1stMEMBERNAME………………………..Please sign back of photoAs acceptance of BDAS RulesSign………………………00PHOTO 1stMEMBERNAME………………………..Please sign back of photoAs acceptance of BDAS RulesSign………………………537210053975PHOTO 4thMEMBERNAME………………………..Please sign back of photoAs acceptance of BDAS RulesSign………………………00PHOTO 4thMEMBERNAME………………………..Please sign back of photoAs acceptance of BDAS RulesSign………………………365760053975PHOTO 3rdMEMBERNAME………………………..Please sign back of photoAs acceptance of BDAS RulesSign………………………00PHOTO 3rdMEMBERNAME………………………..Please sign back of photoAs acceptance of BDAS RulesSign………………………74891901028065HOTO 5thMEMBERNE………………………..ase sign back of photoAs acceptance of BDAS RulesSign………………………00HOTO 5thMEMBERNE………………………..ase sign back of photoAs acceptance of BDAS RulesSign……………………… ................
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