APPLICATION FORM FOR MEMBERSHIP 2000

Print out the following Application form and return it with the appropriate fee to the Ballincollig GAA club, Powdermills, Ballincollig, Co. Cork

APPLICATION FORM FOR MEMBERSHIP 2000

SURNAME: ______________________________________________________________

ADDRESS: _______________________________________________________________

TELEPHONE NO: _________________________________________________________

GENTS CHRISTIAN NAME: _________________________P.P.U.I. NO._____________

LADIES CHRISTIAN NAME: _________________________P.P.U.I. NO.____________

FAMILY	£50	STUDENT	£20	JUVENILE	£10
GENTS	£30	O.A.P. SINGLE	£15	FEE PAID
LADIES	£30	O.A.P. COUPLE	£25	CASH/CHEQUE

FAMILY MEMBERSHIP INCLUDES PARENT(S) AND CHILDREN FROM 11 TO 16 YEARS OLD.

FOR STUDENT MEMBERSHIP, STUDENT I.D. CARD MUST BE PRODUCED AS PROOF.

JUVENILE MEMBERSHIP (INDIVIDUAL) NOT ACCEPTED ON THIS FORM

NAMES AND AGES OF JUVENILES UNDER 16 YEARS OLD ON FAMILY MEMBERSHIP

NAMES	SEX	DATE OF BIRTH

JUVENILES DATE OF BIRTH MUST BE ON THE FORM

IF PREVIOUSLY REGISTERED WITH THE RANGES (OR ANY OTHER) P&P CLUB PLEASE STATE:

CLUB______________ HANDICAP________YEAR______ REG. NO__________

IF YOU PLAY GOLF PLEASE STATE:

CLUB______________ HANDICAP________ YEAR__________

SIGNATURE OF APPLICANT:__________________________ DATE:_____________

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