PART 1 - PERSONAL DETAILS - to Be Completed by ALL Members Where Different to Held Details

PART 1 - PERSONAL DETAILS - To be completed by ALL members where different to held details.

Name of Member

Address & Postcode

Telephone Home:
Numbers

Work:

Mobile:

Name of Employer

Email Address

Date of Birth

Subscriptions:Playing Member£60.00£

Student Member£20.00£

Lady Member£10.00*£

Non-Playing Member£25.00£

Vice President£30.00(min)£

TOTAL ENCLOSED£

·* Lady Member’s subscription does not include full membership of the clubhouse. If this is required, a separate application should be made.

PART 2: PAYMENT OF ANNUAL SUBSCRIPTION -To be completed by ALL members.

Please delete as appropriate:

a) I have made my payment online through the club website

b) I have paid the amount above using a BACS (internet) transfer.

c) I wish to pay by Bank Standing Order, and have an existing SO in place.

d) I wish to pay by Bank Standing Order, andhave completed the form overleaf.

e) I enclose cash or a cheque for the amount above.

For Online Payment visit:

Please make cheques payable to LEODIENSIAN RUFC

BACS or Internet payments to be made to Account Number: 00192150 / Sort Code: 16-23-37.

PART 3: APPLICATION FOR MEMBERSHIP - New members only

Applicant’s SignatureDate

Proposed By:Name:Signature:

Seconded By:Name:Signature:

Were you registered at your previous club?YES/NO

If Yes, Previous Club’s Name & Address

BANK STANDING ORDER FORM - Please complete if applicable & return to JAMES DEBENHAM

Name of Bank:

Address of Bank:

Account Number:

Please set up the following standing orders.

Please cancel any existing standing orders which pay ‘Leodiensian RUFC.’

Please cancel any existing standing orders which pay ‘Leodiensian Club’

Do NOT cancel existing standing orders to ‘Leodiensian Club Draw.’

1) Please pay the sum of £15.00 immediately, and thereafter every 1st October until further notice.

2) Please pay the sum of £15.00 on 1st November 2008, and thereafter every 1st November until further notice.

3) Please pay the sum of £15.00 on 1st December 2008, and thereafter every 1st December until further notice.

4) Please pay the sum of £15.00 on 1st January 2009, and thereafter every 1st January until further notice.

*If any of the above dates are passed, please pay that standing order with immediate effect

TO:Royal Bank of Scotland PlcAccount Number:00192150

27 Park RowSort Code:16-23-37

LeedsAccount Name:Leodiensian RUFC

LS1 5QBReference:Account Name

I hereby authorise you to debit my account with each such payment:

Signature:

Name:

Date:

Address: