NEW MEMBERSHIP APPLICATION FORM

Name………………………………………………………………..

Address……………………………………………………………..

…………………………………………………………………….…

Tel No…………..………………………….

Date of Birth………/……/………………...

Type of Membership Required

TYPE	COST	TICK
Senior Member	£60.00 (includes a £20.00 Joining fee, colour deluxe map book and handbook)
Senior Member (Man and Wife / Partner)	£75.00 (includes a £20.00 Joining fee, colour map book and handbook)
Intermediate Member (under 18 at April 1^st)	£25.00
Junior Member (under 16 at April 1^st)	£10.00
Senior Citizen	£60.00 (includes a £20.00 Joining fee, colour deluxe map book and handbook) concession after 3 years
Senior Citizen (Man and Wife / Partner)	£75.00 (includes a £20.00 Joining fee, colour deluxe map book and handbook) concession after 3 years
Family Membership	£80.00 (A maximum of 2 senior permits for Mother, Father or Guardians plus 1 Youth / Intermediate plus up to 3 junior permits (total 6 permits)
Night Syndicate Card	£25.00 (Senior & Senior citizen only)
Full Colour Deluxe Map Book	£2.50
Car Park Security Key	£3.00

Please print this page and complete the above form in BLOCK CAPITALS and send it,
along with your remittance and 9" x 6" stamped addressed envelope to: -

Northwich Anglers Association
P O Box 18
Northwich
Cheshire
CW9 5SE

NOTES: -

Please do NOT send cash in the post.
Cheques made payable to: - Northwich Anglers Association.
If you prefer not to post you can take this form and join in person at the club house on a Friday evening or at these tackle shops: - Dave's of Middlewich, Vale Royal Angling Centre.