Lewis & Harris Sports Council

Affil combined form 2016.doc

Lewis and Harris Sports Council

Comhairle Spòrs Leòdhais agus Na Hearadh

Lewis Sports Centre, Stornoway HS1 2PZ

Ionad Spors Leodhais Steornabhagh HS1 2PZ

Tel: 01851 822785

Email:

L H S C AFFILIATION FORM 2016-2017

Please complete the form as accurately as possible and return to:

Steven Munro, Sports Development Officer, Comhairle nan Eilean Siar,

Lewis Sports Centre, Stornoway, Isle of Lewis, HS1 2PZ.

Tel: 01851 822785

PLEASE PRINT DETAILS & COMPLETE ALL SECTIONS IN FULL

Category (Please Circle):AssociationOrganisation/ClubIndividual

Name of Association/Organisation/Club/Individual: …………………………………………………….

Name of Sport you represent: ………………………………………………………

Name of Regional or National Associations (if any) to which affiliated:

OFFICE BEARERS - Association/ Organisation/Club
Chairperson’s Name ……...... ………...….. Tel No: H …………… W……………... Mob ……………………….
Address ………………………………. Postcode………….... E mail ……………………..
Secretary’s Name ……...... ………...….. Tel No: H …………… W……………... Mob ……………………….
Address ………………………………. Postcode………….... E mail ……………………..
Treasurer’s Name ……...... ………...….. Tel No: H …………… W……………... Mob ……………………….
Address ………………………………. Postcode………….... E mail ……………………..
Individual Member only
NAME: ...... Tel No: H …………… W……………... Mob ……………………….
ADDRESS:...... …………..…….. .POST CODE...... …….. E MAIL …………………………
FACILITIES/MEETING PLACE
Facilities where Club/Organisation normally meets:
Day and Times when Club/Organisation meets: / DAY / TIME

JUNIOR SECTION (To be completed by Associations/Organisations/Clubs)

Does the Clubs/Club operate a Junior Section? □ YES □ NO
Does your Clubs/club have a Child Protection Policy please tick the box □ YES □ NO

Supported by Comhairle nan Eilean Siar

Le taic bho Comhairle nan Eilean Siar

Lewis and Harris Sports Council (Comhairle Spòrs Leòdhais agus Na Hearadh)

MEMBERSHIP(Only complete the below section if you are an association)

NAME OF CLUB / SECRETARY’S NAME / ADDRESS / TEL NO

MEMBERSHIP DETAILS

AGE

/ MALE / FEMALE / TOTALS
PRE-SCHOOL
PRIMARY SCHOOL
SECONDARY SCHOOL
ADULTS

COACHES AND COACHING QUALIFICATIONS

NAME / COACHING QUALIFICATION

OFFICIALS AND QUALIFICATIONS eg Football referee, Timekeeper in athletics.

NAME / QUALIFICATION

Associations seeking affiliation for the first time must include a copy of their Constitution.
Associations re-affiliating should include a copy of their Constitution if it has been altered.
Please enclose cheque/postal order for £40/£30/£25 payable to Lewis & Harris Sports Council for affiliation fee.

Print Name ……………………………… Signed ………………………...... Date ……………………….....

Position in Association/Club/Organisation ………………......
Please return your completed affiliation form as soon as possible and no later than Thursday 31st December 2015

DATA PROTECTION

We wish to register the personal details you have provided on this form toour database. This will be used for sending out information on future events and other developments. We may also use photographs for publicity. If you do not wish your association’s and your affiliated club’s contact details and photographs to be stored on database please tick this box. 

For Office Use Only - (To Be Completed by Staff Member Processing Booking Form)
Date / Staff Signature / Amount Paid