West Midlands Police Sports & Social Club
Retired Membership Application Form
Please print the form off and ensure you complete ALL sections of the form. You can then either post or fax the form back to the Sports Club.
Forms that are returned before the 1ST of each month will be processed for that month. Once we have received confirmation from payroll, you will be issued with a membership card. If the form is sent back after the 1ST of each month, your membership will not be processed until the following month.
Last Name …………………………………………………………………………..Mr/Mrs/Miss/Ms…………………………
First Name(s) ………………………………………………………………………Pension Number...... ………………..
Home Address ………………………………………………………………………………………………………………………..
...... Postcode…………………………
Telephone ………………………………………………Email Address ......
Please tick if you wish to join our mailing list for weekly updates on offers?
(please ensure email address provided)
1. I wish to become an Honorary member of WMP Sports & Social Club
As a member of staff leaving the Police Authority on pension, you
become an Honorary Member of the club at no cost. However, if
you wish to play sport, or use the facilities which bears a cost to the
club you will need to become a Full member.
Membership to the Lottery is open to all retired members.
2. I wish to become a Full Member of WMP Sports & Social Club
Membership fee equates to £49.44 per annum and will be deducted
From Pension at a rate of £4.12 p.c.m.
I wish for my subs to be aligned to the following LPU/Dept......
3. I wish to become a member of the WMP Sports & Social Club Lottery
Lottery equates to £1 per week and will be deducted from my
salary at the rate of £4.35pcm.
I authorise deductions as indicated to be taken from my pension.
Signed ……………………………………………………………………………… Date …………………………………………….
Office Use Only
Date received…………………………………………….. Membership Number……………………………………