Print Form | Close Window
ACAUK
MEMBERSHIP APPLICATION FORM
First name: ____________________ Init: ______ Last: ____________________
Address: ____________________________________
____________________________________
____________________________________
____________________________________
Post Code: _____________________
Tel (H):
____________________
Tel (W): ____________________
Fax:
____________________
Tel (Mob): ____________________ E-mail: ________________________________
UKA Coaching Level (or
equivalent):
_________ Coaching
Area: _____________________
Main Coaching Events: 1] ________________ 2]
________________ 3] _________________
Main athletes coached: ____________________________________ Event: ______________
____________________________________ Event: ______________
____________________________________ Event: ______________
____________________________________ Event: ______________
____________________________________ Event: ______________
Subscription enclosed: £
______
(£25)
Donation: £
_______
I give permission for any information submitted on
this form to be shared with other members of ACAUK ___ (Y/N)
Signed: ____________________________________
Date: ______________
Please return to: The Acting Secretary, ACAUK,
3 Arragon Gardens, Streatham, London SW16 5LY
For Office use: Date received: ___________ Membership
No. Allocated: ___________
| 