1. MR / MRS / MISS (delete as applicable)
2. CHRISTIAN NAMES ………………………………………………………………………
3. SURNAME ………………………………………………………………………
4. ADDRESS ………………………………………………………………………
……………………………………………………...POSTCODE ………………
5. TEL. NO. ……………………………………...
6. E MAIL ………………………………………
7. DATE OF BIRTH ………………………………………
8. MEMBERSHIP CATEGORY APPLIED FOR : (Please tick as appropriate)
LOCAL (
) Who reside or have a second home for which
they are accountable for council tax and not used for
financial gain, within a twenty-mile radius of Penrith Post Office
(note; all correspondence will be
sent to local address)
COUNTRY ( )
Resident outside this radius
9. MEMBERSHIP AGE CATEGORY APPLIED FOR: (Please tick as appropriate)
SENIOR ( ) Over the age of 21 on 15th January during the present season
JUNIOR
( ) Aged 21 years and
under on 15th January during the present season
SENIOR CITIZEN ( ) Over the age of 65
(men &women) on 15th January during the present season
REGISTERED DISABLED ( ) Please
provide written evidence. A photocopied document is acceptable
10. Please tick ( )
if the married couples rate is applicable (see subscriptions)
11. Proposed by:
Full name AND signature of existing member …………………………………………...
……………………………………………
12. Seconded by:
Full name AND signature of existing member ………………………...............................
……………………………………………
13. How did you hear about the Association ? (Please
specify which advert if applicable) ………………………………………………………………………………………………………
If you do not know any existing members but you wish to apply for membership,
please write and give your reasons for wishing to join Penrith Angling
Association together with some details about yourself. This will enable the
committee to consider your
application, which we hope, will be successful.
PLEASE RETURN
THIS FORM TO: Mr A Dixon, Honorary Secretary, Penrith Angling Association, 3
Newtown Cottages, Skirwith, Penrith, Cumbria CA10 1RJ
(Please do not send any payment with this
form)