2011MembershipForm

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					W.L.A.C Membership                                                                         Membership No:
        st                st
from 1 April 2011 til 31 March 2012


                  WHEN COMPLETING THIS FORM PLEASE USE BLOCK CAPITALS

Title
Forenames
Surname


Date of Birth                                                            Gender              Male / Female


Full Postal Address




Home Tel. No.                                      Business Tel. No.
Mobile


Email Address


How did you hear about us


If you have a Family           e.g. Emma (Partner) John (Son 14yrs) Susan (Daughter 6yrs)
Flying or Family Social
membership please list
your family members and
your relationship here.


Occupation
Company Name
Give Club Assistance in relation to your occupation                                               YES / NO


Aircraft Owner                 Details required only for aircraft based at White Waltham
Aircraft Make
Aircraft Registration
Group Name
Group Members



Flight Tests/Licences                                                                      Expiry Date




                                                                                               PTO………..
(1)     I shall comply with the Club’s rules and bye laws, (which I have read), the Air Navigation Order and Regulations,
        the Rules of the Air and Air Traffic Control Regulations, and any other relevant provision of English or Foreign
        Law, the Flying Order Book (copy on website www.wlac.co.uk), Aerodrome Rules and Regulations, as amended
        and in force from time to time, and any instructions given by any officer or by any instructor or officer of the
        Company.

WAIVER OF CLAIMS
(2)   No claim shall at any time be made by or on behalf of myself or my estate against the Club or the Company, their
      servants or agents in respect of any loss or damage to property or any personal injury (whether fatal or otherwise)
      sustained or suffered by me, howsoever caused (unless the loss or damage is directly due to negligence on the part
      of the Club) and I understand that no compensation will be paid to me or my estate by the Cub or Company in
      respect of such loss, damage, injury or death.

INDEMNITY
(3)   I indemnify the Club and/or the Company as the case may be in respect of any penalties, damages, expenses,
      liability, legal cost or insurance excess which may be suffered or incurred by the Club and/or Company in
      consequence or any proceedings, claims or demands or whatever nature brought or made at any time after I shall
      become a member of the Club by any person arising out of or in connection with my membership of the
      Club or my use of the Club’s or Company’s aircraft or facilities.


                           PLEASE TICK BOXES BELOW TO INDICATE
                            MEMBERSHIP TYPE AND PAYMENT METHOD

                               Cash / Cheque                                  DIRECT DEBIT
                               / Credit Card
  Membership Type                                      Monthly            Annually         Payment by:
      Full Flying                  £330.00                £31.00             £310.00          New Direct Debit
      Family Flying                £420.00                £39.50             £395.00
      Retired Flying               £185.00                £18.00             £175.00          Existing Direct Debit
      PPL Student                  £200.00                £19.50             £195.00
      Social                       £155.00                £15.50             £150.00
      Family Social                £185.00                £18.50             £180.00
      Retired Social               £79.00                  £8.50               £74.00
      Retired Family Social        £110.00                £11.00             £110.00
      Overseas/Country             £180.00                £17.50             £175.00




Signed:___________________________________                           Date: _________________________________

* If new, please complete Direct Debit form enclosed. ** Existing Direct Debits will be collected automatically,
commencing 6 April 2011 in accordance with your existing mandate. If you require a VAT invoice please request one
from accounts.

The details requested for on the enclosed form will be kept on the computer at White Waltham Airfield. The details are
held purely for membership purposes to allow us to tailor our communications with you. Your details will not be divulged
to any third party unless required by law.

				
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