Uxbridge Rovers Angling and Conservation Society by pptfiles

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									                  Uxbridge Rovers Angling & Conservation Society
           Membership Application 2011/12 (Membership to 15th June 2012) Join on line at www.uracs.co.uk
       Use BLOCK CAPITALS & a separate form for each prospective member. (Except Family Ticket applications)

  Forename:
  Surname:
  Address:




  Post Code:
  Telephone Number:
  Email Address:

 Car Registration:
 (Car park permits cannot be issued without this information)
Please complete this form and return it together with:
     (i) a passport size photograph
     (ii) A 92p stamped self addressed envelope (min size 6.5" x 9") (A5),
     (iii) your remittance (Cheques and postal orders made out to Uxbridge Rovers Angling & Conservation Society).

TO    URACS Membership Secretary, PO Box 252, Evesham, WR11 9AQ

                               CLUB SUBSCRIPTIONS 2011/12 (membership to 15 June 2012)
Senior Member                                                                                        ….      £ 80.00* [           ]
Senior Member & Partner **                                                                           ….      £ 81.00* [           ]
Family (Husband, Wife & Juniors)                                                                     ….      £ 81.00* [           ]
Please name all Anglers.
                                                                                                     ….      £ 60.00         [    ]
Intermediate (student in full time education 18-21Yrs) (Student Union No …………)
Old Age Pensioner                            (Please include a copy of your rod licence)             ….      £ 53.00*        [    ]
Pensioner & partner **                       (Please include a copy of your rod licence)             ….      £ 54.00*        [    ]
Disabled                                     (Please include a copy of your rod licence)             ….      £ 43.00*        [    ]
Disabled member & partner **                 (Please include a copy of your rod licence)             ….      £ 44.00*        [    ]
Junior (See note below)                      (Please include a copy of your rod licence)             ….        FREE          [    ]
(Date of Birth ....... /....... /........)
Optional Extras: Night Permits ***   Batchworth Lake, River Colne (Rickmansworth),                           £ 35.00          [   ]
                                     Golf Course Lakes, Billet Lane and Troy Lake.
As a limited number are available (£35.00 each venue) please contact the Membership
Secretary Tel: 01386 428660 for availability
   * Includes a £5.00 fee for the rule book and fisheries guide
  ** Partner is defined as spouse or spouse equivalent
 *** Night permits are only available with Senior, Pensioner or Disabled membership

Paid by Postal Order/Cheque                                                           Total Amount           £ ................

Signed      ....................................................................
Please allow up to 28 days for postage and processing.
NOTES FOR JUNIOR MEMBERS.
Applications from juniors are most welcome; however, application forms must be countersigned by a parent or guardian.
A junior member as defined under the society rules is any person who is over 12 years old but less than 18 years old on
15th June 2011. Juniors under 12 are free with an adult membership
I agree to my son/daughter joining Uxbridge Rovers A.S. as a junior member. I am aware of the club rule that
junior members under the age of 12 years must be accompanied by an adult when attending the Society's waters.


Signed            ………………………………….…………….                                      Parent/Guardian          Dated   ……………




For Office use only              Accepted                         Posted                              Number

								
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