Club registration forms

28/3/2016 - 27/3/2017

 

2014 FORM FOR IBF/BCSA/BGA CLUB MEMBERSHIP &  PL  INSURANCE

70  Member Club

28/3/16 till 27/3/17

                      All questions to be completed fully in block capitals. All officials must be registered with the Criminal Records Bureau

                    Please complete in BLOCK CAPITALS (illegible forms will be returned) 

Renewal Date 28/3/2017

LIMIT OF INDEMNITY 5,000,000

  Please Note : Insurance will not commence until a correctly completed  and signed proposal form and your payment is received by our insurance broker LRO Insurance. All cover is subject to the terms, conditions and exceptions of the master policy held by our broker and is available for inspection upon request. Please read the following declaration, sign at the bottom and return this form, together with your payment.

Declaration: I declare that to the best of my knowledge and belief there are no known incidents or circumstances that might give rise to a claim

 

  Signed    ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. Date ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .

You can pay over the internet via Internet Banking or

Paypal (sombogb@blueyonder.co.uk) if using paypal please ensure you pay their admin fee or add 5% or

Cheque sent to HQ or contact HQ for internet Banking Details

 

CLUB VENUE ADDRESS TOWN PO CODE Discipline

Times of Sessions

 
 
 
 
 
 
 
 
 
             
             

Club Secretary

Surname

Christian (First) Name

Address

Town

County

PO Code

Telephone & Email