THE LONDON FOOTBALL COACHES ASSOCIATION by 5zA94m

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									             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 awjprem@btinternet.com 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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