Membership application form - AWS
CURRACH ÁTHA, CO. NA MÍ (CURRAHA, CO. MEATH) WWW.CURRAHAGAA.COM
MEMBERSHIP APPLICATION 2016
EMAIL – [email protected] CATHAOIRLEACH: FRANKIE O’CONNOR RÚNAÍ: PAUL O’CONNOR
APPLICANT INFORMATION Name: Date of birth:
Email:
Mobile Phone:
Current address:
MEMBERSHIP TYPE
☐
Please tick one only: Family
☐
Playing Adult
☐
Non-Playing Adult
☐
Juvenile
Student
☐
☐
OAP
EMERGENCY CONTACT Name of a relative: Address:
Mobile Phone:
Relationship: SPOUSE INFORMATION IF FAMILY MEMBERSHIP Name: Date of birth:
Email:
Mobile Phone:
CHILDREN IF FAMILY MEMBERSHIP Name
Date of Birth
Name
Date of Birth
Name
Date of Birth
Name
Date of Birth SIGNATURES
Signature of applicant:
Date:
Signature of spouse
Date:
(only for Family Membership):
PAYMENT DETAILS For 2016 the AGM has approved the following Fee structure:
Family / Playing Adult - €120
Non-Playing Adult / Juvenile / Student / OAP - €60
Payment should be made by Bank transfer (see Bank Details opposite – ensure that you give your name as the payment reference), By cash / cheque to The Chairman (Frankie O Connor), The Secretary (Paul O Connor), The Membership/Registration Officer (Ray Toner) or indeed any member of the Committee. Payment is due before the end of February 2015
Bank Details: IBAN IE83 AIBK 9323 9602 3416 97 BIC AIBKIE2D
Note: Playing Members are not covered by Insurance unless fees have been paid. Why not add your Annual Lotto Numbers at the same time – Just €90 for 1 line Enter your numbers here and remit the amount with your membership fees – select 4 numbers from 1 to 28:
MEMBERSHIP APPLICATION 2016
EMAIL – [email protected] CATHAOIRLEACH: FRANKIE O’CONNOR RÚNAÍ: PAUL O’CONNOR
APPLICANT INFORMATION Name: Date of birth:
Email:
Mobile Phone:
Current address:
MEMBERSHIP TYPE
☐
Please tick one only: Family
☐
Playing Adult
☐
Non-Playing Adult
☐
Juvenile
Student
☐
☐
OAP
EMERGENCY CONTACT Name of a relative: Address:
Mobile Phone:
Relationship: SPOUSE INFORMATION IF FAMILY MEMBERSHIP Name: Date of birth:
Email:
Mobile Phone:
CHILDREN IF FAMILY MEMBERSHIP Name
Date of Birth
Name
Date of Birth
Name
Date of Birth
Name
Date of Birth SIGNATURES
Signature of applicant:
Date:
Signature of spouse
Date:
(only for Family Membership):
PAYMENT DETAILS For 2016 the AGM has approved the following Fee structure:
Family / Playing Adult - €120
Non-Playing Adult / Juvenile / Student / OAP - €60
Payment should be made by Bank transfer (see Bank Details opposite – ensure that you give your name as the payment reference), By cash / cheque to The Chairman (Frankie O Connor), The Secretary (Paul O Connor), The Membership/Registration Officer (Ray Toner) or indeed any member of the Committee. Payment is due before the end of February 2015
Bank Details: IBAN IE83 AIBK 9323 9602 3416 97 BIC AIBKIE2D
Note: Playing Members are not covered by Insurance unless fees have been paid. Why not add your Annual Lotto Numbers at the same time – Just €90 for 1 line Enter your numbers here and remit the amount with your membership fees – select 4 numbers from 1 to 28:
