MEMBERSHIP APPLICATION FORM 2014-15

NAME OF CLUB/ORGANISATION:

SPORT/ACTIVITY:

OFFICE BEARERS:

SECRETARY: / CHAIRMAN: / TREASURER:
POST CODE: / POST CODE: / POST CODE:
TELE: (Day) / TELE: (Day) / TELE: (Day)
(Evening) / (Evening) / (Evening)
(e-mail) / (e-mail) / (e-mail)

NUMBER OF SENIOR CLUB MEMBERSCLUB TRAINING SENIORS (DAY)

NUMBER OF JUNIOR CLUB MEMBERSCLUB TRAINING JUNIORS (DAY)

CLUB COACHES
Name: / Name: / Name: / Name: / Name:
Address: / Address: / Address: / Address / Address:
Tele No: / Tele No: / Tele No: / Tele No: / Tele No:
Level of Qualification / Level of Qualification / Level of Qualification / Level of Qualification / Level of Qualification

If you have more than 5 coaches please attach details on separate sheet.

This information is required to assist the Club Sport Berwickshire with Summer/Easter Sports Schemes, Coaching Development Initiatives etc.

PREVIOUS FINANCIAL ASSISTANCE FROM CLUB SPORT ROXBURGH (PREVIOUS 2 YEARS ONLY)
SPORT AWARD SCHEME (INDIVIDUAL APPLICANTS)
Name: / Name: / Name: / Name: / Name:
Address: / Address: / Address: / Address / Address:
Purpose of Grant / Purpose of Grant / Purpose of Grant / Purpose of Grant / Purpose of Grant
CAPITAL GRANT/REVENUE GRANT SCHEME
Name: / Name:
Address: / Address:
Purpose of Grant / Purpose of Grant
NATIONAL AND/OR REGIONAL ASSOCIATIONS TO WHICH AFFILIATED
Name: / Name: / Name:

The above organisation of which I am an Office Bearer, agrees to abide by the rules and Constitution of Club Sport Roxburgh and notes that the Annual Affiliation Fee is £20.00 which is enclosed herewith.

Signed ...... Date......

The completed form and cheque/postal order made payable to Club Sport Roxburgh for £20.00 should be returned to:-

Secretary, Club Sport Roxburgh, Borders Sport & Leisure Trust, Melrose Road, Galashiels, TD1 2DU

Please note that all the above information will be kept on database, in accordance with the Data Protection Act 1984, and that you may be contacted with information regarding other Sports Development / Club Sport Berwickshire Initiatives. If you do not wish to receive this information please tick the box 