Active Hampshire Full Membership Form

APPLICATION FOR FULL MEMBERSHIP

Prospective members of Active Hampshire must have attended at least three activities and be known to two committee members before an application for full membership can be considered.

Mr/Mrs/Ms	Forenames	Last Name
Address
		Home Phone
		Work Phone
		Mobile Phone
Email Address		Date of Birth ___/___/19___ Sex M / F
One or more CSV contact lists may be produced during the year and sent to all FULL members of Active Hampshire. The details that are included with your name are address, email and home phone number. It is your responsibility to inform the Membership Secretary before publication if you would like any of your details removed from such a list.

Member of another IVC Affiliated Club ? Yes / No

if yes, which?

Three events you have been to and obtained officer signatures at those events:
1.	Officer Signature:	Date: ___/___/____
2.	Officer Signature:	Date: ___/___/____
3.	Officer Signature:	Date: ___/___/____

PLEASE UNDERLINE BELOW ANY ACTIVITIES BELOW YOU ARE PREPARED TO ORGANISE.
ARTS & INTERESTS Cinema Theatre/Drama Books/Literature Visual Arts Museums/Galleries Buildings / Architecture Arts and Crafts Clothing and Fashion Visiting/Discovery	OUTDOOR Camping/Hostelling Travel (UK & Abroad) Walking/Climbing Water Sports Equestrian Flying & Aviation Motor Sports Snorkelling/Sub-Aqua Pitch & Putt (Golf)	SPORT Badminton Squash Tennis Cycling Swimming Athletics Cricket Football Rounders	MUSIC & DANCE Barn Dance Modern Jazz Jive Jazz, Blues, & Soul Classical/Opera Pop Music Nightclubs/Discos Karaoke Comedy Clubs Concert Tours	LEISURE Dining Out/Dining In Pub Nights Games/Quiz Nights Skittles Evenings Ten Pin Bowling Ice Skating/Skiing Treasure Hunts House Parties Disco/Music Cruises

Data Protection Act: The information supplied on this form will be stored on a computer to facilitate bulletin distribution and club administration. Your signature below will be taken as permission for this.

I/we hereby apply for Membership of Active Hampshire. I/we agree to abide by the rules of the club as laid down in the Constitution and Club Rules of Conduct, which are available for inspection on the Active Hampshire web site at http://www.ActiveHampshire.org.uk and on application to the Secretary.

I/we will endeavour to organise at least two events per year towards the club programme.

I/we enclose the annual subscription of £15.00 GBP per person and understand that this will be returned if this application for membership is not accepted by the Committee of Active Hampshire. I/we acknowledge that Active Hampshire reserves the right to refuse this membership application without assigning any reason.

Signed	Date
Please print, sign and return this form to: Ian McCormack (Active Hampshire Membership Secretary) 11 Taylor Drive, Bramley, Tadley Hants RG26 5XB Tel: (01256) 886066