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WELSH CLAY TARGET SHOOTING ASSOCIATION

Application for Membership

 

Please Print and return this form to : MRS JY REES  -  32 PLAS MALDWYN,  TY GWYN ROAD,
CAERSWS, POWYS   SY17 5HA  

Tel: 07751 353020 (Phone after 6PM only please)

Membership No. ................... Shotgun Certificate No.............................

PART A:

I wish to apply for membership: Please tick

Adult (£55.00) …...  

Junior (under 21yrs)  £30-00 …...  Senior Cit.(65yrs & over) £40 …... Club (£30)  ….…

Have you ever been refused membership of any shooting organization.

Please state Yes or no ………

If you are a member of any other Clay shooting Association ie: CPSA please state :

Association Name……………………..……Your membership No………………

Discipline and Class ……………………………………………….

Please print in BLOCK CAPITALS

Surname.............................................…......(Mr. / Mrs. / Miss) DELETE AS APPROPRIATE

Forename(s)...............................................................……….

Address........................................................................………….................................

........................................................

County .......................................................Post Code................................………….

Telephone No..........................................work Tel. No...............................................

_ Please state Date of Birth ........../........../............

Eligibility to Represent WALES .

Born in Wales . Yes/No.  (B) Father born in Wales .  Yes/No.  (C) Mother born in Wales . Yes/No

(E) Number of years you have resided in Wales = …………………………………..

___________________________________________________________________

I enclose my; Bankers Order/Cheque/P.O./ Cash for £………………………..

Cheque / P.O. / should be made payable to W.C.T.S.A. Ltd.

__________________----_______________________________________________

PART B:

BANKERS ORDER. (This is the most convenient and helpful method of payment)

To: W.C.T.S.A.,

Name of Bank.......................................................

Address of Bank..................................................……………………………………………

………………………………………………Post code …………………

Bank Sort Code ..….--……--……   Acct Number ....................................

On receipt of this order please pay to Welsh C.T.S.A. the sum of £...........
and thereafter on the …………………………………………annually until further notice and debit
my / our account accordingly.

20 - 12 - 25  Welsh Member No...........................  A/C No. 30924024

Barclays Bank Plc. 36 Dunraven Place, Bridgend, Mid. Glamorgan , CF 31 1HY

Amount (in words)........................................................................£...................

Name (block Capitals )........................................................................................

Address...............................................................................................................

...........................................................................................................................

A/C No.................................................Signed.....................................Date........................
 

The information given on this application form is stored on computer by the Association to be used only by the Association. The Association is governed by the DATA PROTECTION ACT.