East Midlands Hockey Umpiring Association
Renewal and New Membership Application Form - 2008/09 Season
(PLEASE PRINT THIS FORM OFF AND SEND A SIGNED ORIGINAL)
Full Name: ______
Address: ______
______
______
Post Code: ______
Telephone No: ______(Home)
______(Office)
______(Mobile)
Email address: ______
Date of Birth: ______
Club: ______
Level 1/2/3 Registration No.: ______
Signature: ______TICK BOX
Indicate if you are RENEWING YOUR MEMBERSHIP £
or joining as a NEW MEMBER £
Are you willing to carry out the odd neutral appointment for the Association? £
Indicate if you would be available to be included in a list of Umpires £
willing to umpire University hockey on a Wednesday afternoon
I enclose my cheque for £7.50 as membership fee to the East Midlands Hockey Umpiring Association
(Cheques should be made payable to the East Midlands Hockey Umpiring Association or EMHUA)
PLEASE ENSURE THAT YOU COMPLETE ALL INFORMATION ABOVE EVEN IF IT IS UNCHANGED FROM LAST YEAR - THANK YOU
Notes:
A non-return will result in the REMOVAL of your name from the Associations membership list and NO insurance cover under the Associations policy, but NOT removal from the Level 1 Register.
The Association will not consider non-members for appointment to matches.
The information supplied will be stored on computer and is for use by EMHUA and inclusion in the Men’s League handbook and MRHUA/BCHUA/EMHUA website.
Please return this form and membership fee to: Kevin Ronson
212 Nottingham Road
As soon as possible or Selston
by the 30th September 2008 Nottinghamshire
at the very latest. NG16 6AB