MEM      BILLERICAY & DISTRICT ANGLING CLUB     WEB

NEW Membership Application 1st April 2010 to 31st March 2011

 Please complete the application in CAPITALS

SENIOR MEMBER - ORDINARY                   16yrs and over                 Two passport size photos required with names on the back

   OAP   ( 65yr)s Date of Birth  ____/____/____ Two passport size photos required with names on the back

Surname _______________     Forename ________________

Address___________________________________________

              ___________________________________________

Town    ___________________________________________ 

County____________________________________________         

Post Code_____________             Have you  previously been a BDAC member. YES  /   NO

Tel. No.________________________________

E-Mail _____________________________________

ASSOCIATE MEMBER (Lady Partners ONE ROD ONLY )

Surname  _________________         Forename  __________________________________

FULL NAMES OF JUNIOR MEMBERS   7th Birthday - 16 yrs

1___________________________________________            Date of Birth  ____/____/____

2___________________________________________           Date of Birth  ____/____/____

3___________________________________________            Date of Birth  ____/____/____

4___________________________________________            Date of Birth  ____/____/____

MEMBERSHIP FEES  for 2010/11

ORDINARY                            £62.00          (including joining fee)                 _______________________

SENIOR CITIZEN, DISABLED       £42.00 (including joining fee)             _______________________

LADY ASSOCIATE              £10.00                                                                _______________________

JUNIOR                                   £10.00                                                                _______________________

CLUB BADGE                        £1.50                                                                 _______________________

GATE KEY                               £2.50          (Key required for all gates)         _______________________

KEY FOB (plus Free car sticker) £1.00                                                            _______________________               

                                                                                    TOTAL ENCLOSED        _______________________

 MAKE SURE YOU ENCLOSE:-

1.     PO / Cheque payable to Billericay & District Angling Club 

       SEND TO: P.O.BOX 2046, Wickford, Essex SS 12 9YW.      

2.     Application Form completed and signed.

3.      Two Passport size photographs of Senior member.

I hereby apply for the membership(s) and agree, if my application is accepted, to abide by the rules and by-laws of Billericay & District Angling Club and accept full responsibility for any Juniors embodied in this application and fully understand that my membership may be terminated if they are found unaccompanied by any adult on a club water.

Signed ____________________________             Date___/___/___   

HELPLINE PHONE No. 0844 335 3978 (9am to 9pm only)

NOTES:

Proof of membership will comprise a Membership Certificate which will also be the official receipt.Members who join in the club close season (April & May) will not receive their documents immediately. These will be dispatched after the handbook for the coming season has been printed following any changes agreed at the AGM in March. Closed season applicants can have a temporary payment receipt if they include a s.a.e. with their application form.

PROOF OF DISABLEMENT MEMBERSHIP: The Club requires a copy of the confirmation from DWP of receipt of disability benefit for the period covered by this membership application. A copy of a blue parking badge is NOT acceptable as disability proof.