ROLLS-ROYCE HOCKEY CLUB

MEMBERSHIP FORM 2013/14

Please supply details in BLOCK CAPITALS

Full Name: ......

Home Address :......

......

Post Code...... Date of Birth......

Home Tel No...... Work Tel No......

Mobile No ….………………………………………………………………………

E-Mail ……………………..……………………………………………………

ANNUAL SUBSCRIPTION FEES

Membership is split into two portions – club membership and membership of Rolls-Royce Leisure Association. BOTH OF THESE PORTIONS MUST BE PAID. The Leisure Association membership provides public liability insurance cover.

IMPORTANT: All participants in hockey should wear shinpads and mouthguards. Anyone not wearing such protective equipment does so at their own risk and the club accepts no liability.

Club Membership

Provide completed form and payment as follows.

Amount / Payment / Please Tick
OVER 18 / £45 / Cash or Cheque Payable To Kestrels Hockey Club
UNDER 18 / £5 / Cash or Cheque Payable To Kestrels Hockey Club

If payment is not made before 31/10/2012 the Over 18 subscription rises from £45 to £60.

Leisure Association (LA) Membership

  1. Are you a R-R employee?Yes/No

If the answer is No go to question 2, if the answer is Yes please complete this section

Check Number :......

Are you an existing member of the LA (i.e. payment comes out of your salary)?Yes/No

If the answer is No please complete the Leisure Association Internal membership formand return to the Membership Secretary with this form

  1. Are you the Spouse/Partner or U18 child of a R-R employee?Yes/No

If the answer is No go to question 3, if the answer is Yes complete this section

Name of Spouse/Partner/Parent employed by R-R:......

  1. Are you an ex-R-R employee, or a R-R retiree and under 60 years old?Yes/No

If the answer is No go to question 4, if the answer is Yes please complete this section

Are you an existing member of the LA (i.e. you are making a direct debit payment)?Yes/No

If the answer is No please complete aLeisure AssociationLeavers membership form and a Direct Debit instructionfor £2.90 per month and return to the Membership Secretary with this form

  1. You are a Guest member, please complete the section below

Are you an existing member of the LA (i.e. you are making a direct debit payment)?Yes/No

If the answer is No please refer to the table below

Amount / Payment / Forms / Please Tick
OVER 18 / £38.40 p.a./ £3.20 per month / DIRECT DEBIT ONLY / Leisure Association External Membership form + Direct Debit Instruction
UNDER 18 / £12 p.a./ £1 per month / DIRECT DEBIT ONLY / Leisure Association External Membership form + Direct Debit Instruction

ALL FORMS TO BE RETURNED TO THE MEMBERSHIP SECRETARY (JACKIE WILDHABER)

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