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Franklin County Archers

New Membership Application 1 April 2016 to 31 March 2017

  

NAME: _______________________________________________________

ADDRESS: ____________________________________________________________

_______________________________________________________________

 

Email address_________________________________________

 

PH:  Cell: ________________ Hm: __________________ Wk: ____________________

 

Date of Birth (If under 17):  _________________ Age: _________________

 

FAMILY MEMBERSHIP: (husband and/or wife/Partner plus Dependant Children.  Please include details of all nominated members.  Only those nominated are included in the Membership)

 

NAME:  ____________________ AGE: _____ 

NAME:  ____________________ AGE: _____

NAME:  ____________________ AGE: _____ 

NAME:  _____________________ AGE: ____

 

BACKGROUND:

Archery Experience _________ years.    With F.C.A ___________ years.

 

Are you or any of the Family Membership a current Financial Member of another Target or Field Archery Club?  Yes/No If so, which?  _________________________________

 

TYPE OF EQUIPMENT: please circle appropriate

 

Compound                  Recurve                     Longbow                Yet to acquire

 

MEMBERSHIP SUBSCRIPTION AND JOINING FEES:

Senior:              $55.00

Junior:              $27.50   16 yrs and under

Family:            $110.00

Veteran:           $40.00    55 yrs and over


ANNUAL RANGE FEE CONCESSION CARD

Single: $65

Family: $130

 

Payment Enclosed:  $____________________________________

 

I, and on behalf of the nominated members of my family, consent to Franklin County Archers collecting the details provided in the above Membership Application, retaining, using those details and disclosing them for the purpose of involving the above said persons in the Franklin County Archers activities now and in the future and to also disclose the same details to a third party directly affiliated to Franklin County Archers.  This consent is given in accordance with the Privacy Act 1993.

 

I and on behalf of nominated members of my family, agree to abide by the Constitution and Rules of Franklin County Archers.

 

 

Signed: ____________________________  Date: _____________________

 

Membership will not be confirmed until approval of the Committee, upon which receipt will be issued

Bank account 12 3028 0529 313 00



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