SECTION A - Class of membership ( please check box where appropriate ) New Registration
Re-registration
Senior and U20
£20
Senior and U20
£45
U17/U15/U13
£15
U17/U15/U13
£30
U11
£10
U11
£15
Insurance Only Club Official
- FOC
Beginner
£10
Coach
- FOC
Trainee
£10
Referee
- FOC
Date of birth ID provided
SECTION B - Applicant information Surname
Forenames
Sex
Date of Birth
Home Address
Telephone
Post Code
Mobile
Email
SECTION C - Guardian Information Sex
Forenames
Surname
Date of Birth
Home Address
Telephone
Post Code
Mobile
Email SECTION D - Please state the name of your previous club & Federation ( if not in the UK ) and the year you were last registered. Name of Club Year last registered I declare that the above information is correct. In signing this form I agree that the above named applicant is bound by the laws and resolutions of the National Roller Hockey Association of England. Signed (applicant)
Date
Signed ( Guardian if under 18
Date
Please stay in touch. The National Roller Hockey Association of England will hold and use the data that you have supplied for administrative purposes only and keep you informed of its fundraising activities and other activities. We hope you will want to stay in touch with our work and ask you to regularly to visit www.englandrollerhockey.com
THIS FORM SHOULD BE RETURNED TO YOUR CLUB SECRETARY
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Jul 31, 2013 - diploma (including BTech) at an accredited Higher Education ... Computer Science and Data Processing ... Health Care and Health Sciences.
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Type of medicines (Circle the appropriate one): i. ... Application form for full registration of medicines.pdf. Application form for full registration of medicines.pdf.
