British Surfing Association Membership Application Form 2007

Membership (all types include £5, 000,000 Liability insurance)


• Senior member £30.00  [     ] tick box
• Junior member (under 18 years old on Jan 1st 2006) £20.00 [     ] tick box
• NEW Junior Members £12.00  [     ] tick box
• Family member (2 adults and up to 4 children aged under 18) £40.00  [     ] tick box
• Association / Insured member (Insurance is included in full membership) £15.00  [     ] tick box
  
  BSA Gift Voucher
  £10 [     ]   £20 [     ]    £25 [     ]    £40 [     ]
  
  BSA logo Keyring £1.99   [     ] tick box
  
    *CLOTHING ORDERS PLEASE PHONE FOR AVAILABILITY* 01637 876474
  
  Membership runs for 12 months from the date of joining and includes £5 000 000 Public Liability Insurance Total.
  
  Which type of board do you normally ride?
  Shortboard [     ] Mini Mal [     ] Longboard [     ] Bodyboard [     ] Kneeboard [     ]
  
  £2 of your (full) membership fee will be given to one of the following organisations.
  Please indicate the Association / Federation of your choice. If you do not tick any organisation then your £2 will be given to the Home Nation Federation where you are resident.
  English [     ] Guernsey [     ] Jersey [     ] Scottish [     ] Welsh [     ]

Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Date of Birth . . . . . . . . . . . . . . . . . . .

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

Email . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Telephone No . . . . . . . . . . . . . . . . . . . . . . . .

Signed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Print Name . . . . . . . . . . . . . . . . . . . . . . . . .
(Parent or guardian to sign if the applicant is under 18 years old)

Please make cheque/postal order payable to; British Surfing Association and send it, together with this completed form to: B.S.A. International Surfing Centre. Fistral Beach, Newquay, Cornwall. TR7 1HY

Or fill in your credit card details.
I authorise you to debit my VISA / MASTERCARD / SWITCH (delete as applicable)

Card number __ __ __ __   __ __ __ __   __ __ __ __   __ __ __ __

Signed . . . . . . . . . . . . . . . . . . . . . Expiry Date . . . . . . . . . . .  Sec No. . . . . . . . .Issue No. . . . .

The Information supplied on this form will be kept on computer for purposes as registered under the Data Protection Act. Please indicate by ticking below if you ARE willing for your details to be passed to third parties. tick here [    ]

Tel: 01637 876474 Fax: 01637 878608 Email: info@britsurf.co.uk. Web: www.britsurf.co.uk