THE LONDON FOOTBALL COACHES ASSOCIATION Membership Application Form I wish to *APPLY FOR/RENEW my membership of the London Football Coaches Association for the next 12 months *Delete as appropriate. Please complete all 3 sections below Surname______________________ First Name______________________ Title_____ Address____________________________________________________________________ __________________________ Postcode_____________ Telephone Number_____________ Email: ________________________________________(This item is required. Please print very clearly) L.F.C.A. Membership Number ____________ (If this is a renewal) Personal Information 1 AGE __16-25 __26-49 __50+ 2 GENDER __Male __Female 3 WHICH OF THE FOLLOWING DO YOU MOST IDENTIFY YOURSELF WITH __Black (UK) __Black (other) __Indian/Pakistani __White (UK) __White (other) __Other, please specify___________________________________________________ 4 COACHING QUALIFICATIONS. Please state your most senior qualification.ie “Level 2” ___________________ Year Gained_________ Venue_______________________ 5 CURRENT COACHING INVOLVEMENT Which set most describes your current football coaching: ___ Under 11 players ____ Under 16 players ____ Adults ____ Women ___ None I now enclose: Please tick as appropriate 1) A Direct Debit form (attached) in order to become a permanent LFCA member, cost £20 per year ____ Or - A cheque for 12 month membership (£25.00 made out to “LFCA”) ____ Or - cash, value £25, for 12 month membership ____ 2) Two Passport Type Photographs ____3) Stamped Addressed Envelope (C5 min. size) ___ FAILURE TO INCLUDE THESE ITEMS WILL DELAY YOUR MEMBERSHIP Please return this form along with the indicated items above to: The London Football Coaches Association: 4 Cardiff Way, Abbots Langley, Herts, WD5 0TT UK Signed:__________________________________ Date:________________________ Email address of LFCA firstname.lastname@example.org Membership queries – 07717 538522 Website address of LFCA – www.lfcacoaches.co.uk Instruction to your Bank or Building Society to pay by Direct Debit Please fill in the whole form including official use box using a ball point pen and send it to: Service User Number (SUN) 2 5 4 2 1 2 London Football Coaches Association 4 Cardiff Way, Abbots Langley, Herts WD5 0TT FOR London Football Coaches Association OFFICIAL USE ONLY This is not part of the instruction to your Bank or Building Society. Name(s) of Account Holder(s) Bank/Building Society account number Branch Sort Code Instruction to your Bank or Building Society Please pay London Football Coaches Association Direct Debits from the account detailed in this Instruction subject to the safeguards assured by the Direct Debit Guarantee. I understand that this Instruction may remain with London Football Name and full postal address of your Bank or Building Society Coaches Association and, if so, details will be passed electronically to my To: The Manager Bank/Building Society Bank/Building Society. Address Signature(s) Postcode Date Reference – (official use only) DDI1 Banks and Building Societies may not accept Direct Debit Instructions for some types of account This guarantee should be detached and retained by the Payer. The Direct Debit Guarantee This Guarantee is offered by all Banks and Building Societies that take part in the Direct Debit Scheme. The efficiency and security of the Scheme is monitored and protected by your own Bank or Building Society. If the amounts to be paid or the payment dates change London Football Coaches Association will notify you 10 working days in advance of your account being debited or as otherwise agreed. If an error is made by London Football Coaches Association or your Bank or Building Society, you are guaranteed a full and immediate refund from your branch of the amount paid. - If you receive a refund you are not entitled to, you must pay it back when London Football Coaches Association asks you to You can cancel a Direct Debit at any time by writing to your Bank or Building Society. Please also send a copy of your letter to us.
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