Application Form - NRHA Registration Form

CLUB NAME

SEASON

SECTION A - Class of membership ( please check box where appropriate ) New Registration

Re-registration

Senior and U20

£20

Senior and U20

£45

U17/U15/U13

£15

U17/U15/U13

£30

U11

£10

U11

£15

Insurance Only Club Official

- FOC

Beginner

£10

Coach

- FOC

Trainee

£10

Referee

- FOC

Date of birth ID provided

SECTION B - Applicant information Surname

Forenames

Sex

Date of Birth

Home Address

Telephone

Post Code

Mobile

Email

SECTION C - Guardian Information Sex

Forenames

Surname

Date of Birth

Home Address

Telephone

Post Code

Mobile

Email SECTION D - Please state the name of your previous club & Federation ( if not in the UK ) and the year you were last registered. Name of Club Year last registered I declare that the above information is correct. In signing this form I agree that the above named applicant is bound by the laws and resolutions of the National Roller Hockey Association of England. Signed (applicant)

Date

Signed ( Guardian if under 18

Date

Please stay in touch. The National Roller Hockey Association of England will hold and use the data that you have supplied for administrative purposes only and keep you informed of its fundraising activities and other activities. We hope you will want to stay in touch with our work and ask you to regularly to visit www.englandrollerhockey.com

THIS FORM SHOULD BE RETURNED TO YOUR CLUB SECRETARY

Application Form - NRHA Registration Form - Letchworth Roller ...

Application Form - NRHA Registration Form. CLUB NAME. SEASON. SECTION A - Class of membership ( please check box where appropriate ).

70KB Sizes 6 Downloads 170 Views

Recommend Documents

registration form
(Name of State/Country). MATC appreciates your cooperation in completing the following information, which is needed to meet State and Federal reporting.

Registration Form
Cell Phone (_____)_____-______ ... information and may disclose such information to the above-named Insurance Company(ies) and ... consent will end when my current treatment plan is completed or one year from the date signed below.

Registration Form -
PLEASE TYPE OR PRINT CLEARLY AS YOU WANT IT TO APPEAR ON YOUR CERTIFICATE OF. ATTENDANCE ... Please select one workshop (Limited seats).

registration form -
Hypenica. Concrete.TV. Reputable third parties. Terms and conditions* ... It may be necessary for reasons beyond the control of Hypenica to change the content.

Registration Form -
Venue: Dhanmondi Club Limited, Metro Shopping Mall (Level-6), Dhanmondi. Date: 26th October 2015. Time: 7.00 PM. Deadline Date: 22th October 2015.

Registration form - European Medicines Agency
Windows is either a registered trademark or a trademark of Microsoft Corporation in the United States and/or other countries. Mac is a trademark of Apple Inc.

CCC / CCC+ EXAMINATION REGISTRATION FORM
NOTE : ALL INFORMATION SHOULD BE FILL IN ENGLISH CAPITAL LETTERS ONLY. 1 NAME OF SECRETARIAT. : 2 NAME OF DEPARTMENT. : 3 NAME OF INSTITUTE / OFFICE. : 4 OFFICE ADDRESS. : PHONE NUMBER. 5 NAME AND DESIGNATION OF HEAD OF. INSTITUTE/OFFICE. CONTACT NUM

Registration Form NTA.pdf
Page 2 of 2. Registration Form NTA.pdf. Registration Form NTA.pdf. Open. Extract. Open with. Sign In. Main menu. Displaying Registration Form NTA.pdf.

Scholarship Application Form
Jul 31, 2013 - diploma (including BTech) at an accredited Higher Education ... Computer Science and Data Processing ... Health Care and Health Sciences.

Registration form - European Medicines Agency
Windows is either a registered trademark or a trademark of Microsoft Corporation in the United States and/or other countries. Mac is a trademark of Apple Inc.

Application form for full registration of medicines.pdf
Type of medicines (Circle the appropriate one): i. ... Application form for full registration of medicines.pdf. Application form for full registration of medicines.pdf.