Woking Referees Society Application Form 2019 / 2020

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I HEREBY WISH TO BECOME A MEMBER OF WOKING REFEREES’ SOCIETY, AND ENCLOSE MY SUBSCRIPTION AS FOLLOWS:-

 

 

NAME…………………………………………………………………………………………………………………………...

 

 

ADDRESS…………………………………………………………………………………………………….…………………

 

 

………………………………………………………………………………..POSTCODE……………………………………

 

 

 

TELEPHONES   (H)………………………………………..…     (M)…………………………………………..…………….

 

 

 

E-MAIL ADDRESS…………………………………………………………………………………………………………….

 

 

 

COUNTY FA REGISTERED WITH……………………………………………………..                            

 

 

 

REFEREE LEVEL……………..…………       

..

 

 

DATE OF BIRTH…………………………

 

BY PAYING MY SUBSCRIPTION I AGREE TO ABIDE BY THE RULES OF THE SOCIETYAND THE REFEREES ASSOCIATION. I ACKNOWLEDGE THAT WOKING REFEREES SOCIETY WILL ONLY CONTACT ME BY EMAIL, MAIL OR TELEPHONE WITH REQUESTS AND INFORMATION RELATING TO SOCIETY BUSINESS, REFEREEING OR OTHER RELEVANT FOOTBALL INFORMATION.

 

I ALSO AGREE FOR MY DETAILS TO BE SHARED WITH THE REFEREES ASSOCIATION FOR THE PURPOSES OF BEING A MEMBER OF THE REFEREES ASSOCIATION

 

 

 

SIGNATURE…………………………………………………………DATE……………………

 

 

RETURN TO :-BRYAN JACKSON,

1 WOODSTOCK GROVE,GODALMING,SURREY,GU7 2AX.

 

CHEQUES PAYABLE TO:-  WOKING RA 

 

COST

AMOUNT

FULL MEMBER - OVER 18 –Printed Warbler

(INCLUDES Paper copy of Society Magazine, RA & COUNTY RA SUBSCRIPTION  + PA INSURANCE)

Expires 31/3/2020 – National RA membership until 30/9/2020

£36.00

 

FULL MEMBER - OVER 18 –Electronic Warbler

(INCLUDES pdf copy of Society Magazine sent by email,  RA & COUNTY RA SUBSCRIPTION  + PA INSURANCE)

Expires 31/3/2020 – National RA membership until 30/9/2020

£25.00

 

FULL MEMBER – UNDER 18 – Printed Warbler

(INCLUDES  Paper copy of Society Magazine, RA & COUNTY RA SUBSCRIPTION  + PA INSURANCE)

Expires 31/3/2020 – National RA membership until 30/9/2020

£25.00

 

FULL MEMBER – UNDER 18 – Electronic Warbler

(INCLUDES  pdf copy of Society Magazine sent by email, RA & COUNTY RA SUBSCRIPTION  + PA INSURANCE)

Expires 31/3/2020– National RA membership until 30/9/2020

£14.00

 

AFFILIATE MEMBER

(i.e. Full Member of another Referees Society)

Expires 31/3/2020

£20.00

 

FRIEND OF WOKING SOCIETY

Expires 31/3/2020

£20.00

 

OPTIONAL RA PHYSIOTHERAPY INSURANCE

If required please contact Bryan Jackson

 

 

DONATION   £1,£2,£3,£4,£5,£10 or Whatever

 

 

 

TOTAL