WYTHALL COMMUNITY ASSOCIATION  and  CLUB

MEMBERSHIP  APPLICATION  FORM

Members are entitled to use all parts of Wythall Park within the rules of the Wythall Community Association.

Applications should be made on behalf of all members of a family who may wish to use the facilities, all of which

are provided solely by the Association. Membership of the Community Club is open to application by all paid-up

members of the Association aged 18 years and over. Accepted applications entitle Members to use the licensed

facilities of the Registered Members' Club within the Club rules. Nominations must be supported by a proposer

and seconder, both of whom must be Club Members. Completed application forms should be returned to

Membership Secretary at Wythall House, Silver Street, together with the appropriate fees. Association

membership will be agreed promptly, but those for the Community Club will be determined at the next monthly

ADDRESS (Block capitals)

REASON FOR APPLICATION

                                             Postcode

telephone(optional)

Proposer

Seconder

Subscriptions

One Year

One Year

Five Years

Official

For year ending 31st March 2009 or 2013

Assoc

Assoc &

Association &

Use only

(Club applications includes £5 joining fee each)

only

Club

Club

Individual Member

£1.00

£17.00

£41.00

Rec'd by

Joint Members

£4.00

£28.00

£64.00

…………………….

Over 60's - each

£1.00

£10.00

£20.00

Date

Children living within Wythall parish area

free

…………………….

Children living elsewhere

£1.00

Amount received

cash / cheque

Entered register

…………………..

ACKNOWLEDGMENT OF RECEIPT

We acknowledge receipt of membership application from ………….…….………………………………., together with

for WYTHALL COMMUNITY ASSOCIATION & CLUB