Woking Referees Society Application Form 2011/2012—2012/2013

 

	COST	AMOUNT
FULL MEMBER - OVER 18 (INCLUDES  RA & COUNTY RA SUBSCRIPTION  + PA INSURANCE)  Expires 31/3/2013	£52.00
FULL MEMBER – UNDER 18 (INCLUDES  RA & COUNTY RA SUBSCRIPTION  + PA INSURANCE)  Expires 31/3/2013	£38.00
AFFILATE MEMBER (i.e. Full Member of another Referees Society) Expires 31/3/2013	£20.00
FRIEND OF WOKING SOCIETY Expires 31/3/2013	£20.00
OPTIONAL RA PHYSIOTHERAPY INSURANCE	£5.00
	TOTAL

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

 

 

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

 

ADDRESS…………………………………………………………………………………………

 

……………………………………………………………………………………………………..

 

COUNTY………………………………………POSTCODE……………………………………

 

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

 

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

 

LEVEL………………………              DATE OF BIRTH…………………………

 

I AGREE TO ABIDE BY THE RULES OF THE SOCIETY

 

 

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

 

 

RETURN TO :-BRYAN JACKSON,

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

 

CHEQUES PAYABLE TO:-  WOKING RA 

Return to Home page