ࡱ> 695g HbjbjVV 3,r<r<H NNL02222!!!giiiiii$R!!!!!22!22g!g2`ͯvRS0X!!!!!!!!!!!!!!!!!!!!!!!N n: Blackheath Football Club Ltd 2011/2012 Membership Application Form Subscriptions are now due. Please print out and complete this application form in full (Block Capitals please), and return it with your subscription to: Peter Brown & Mandy Allen, Membership Office, 74 Old Dover Road, Blackheath, London SE3 8SY tel 020 8293 5980 email:  HYPERLINK "mailto:membership@blackheathrugby.co.uk" membership@blackheathrugby.co.uk Membership Number New Member .. TitleFore names.Surname.. Address..Post CodeTel HomeOfficeMobile.. Occupation. Email Please do not provide your email address if you DO NOT wish to receive communications from the Club. Season ticket Member* 150 . With car parking 200. With stand seat 180Stand seat & parking 230. Mens Playing * 150 (140 if paid before 10th October 2011).. Please note that players other than the Mens 1st squad must have paid their subscriptions of 150 (140 if paid before 10th Oct) to be eligible for team selection and be covered by the RFU insurance. Previous club if new.. Main playing position............................... Parent/Guardian of Mini/Junior & U18 players in 2010-2011 *90 With Car Parking 140. With stand seat 120. With stand seat & car parking 170.. Friends of the Club* ..Members who are keen to support the Club financially by making a minimum donation of 500 plus their 150 membership fee. Friends meet on match days in the Barbarians Bar and may bring in one guest free. If you would like to be contacted to claim gift aid for the above donation please tick here.. Full Time Student or Youth Under 21 *80 PlayerNon Player..students please send copy of Student Card. All rights as Season Ticket Membership Club Membership:.. 50 includes benefits except free access to first team home games and the facility to apply for International match tickets at Twickenham unless a social member prior to 2005/6. School Age: ..Free to non-players who are full time at school. Includes all appropriate membership benefits and free access to home games with an adult (excluding Cup matches, special games and facility to apply for International Tickets). I apply for membership of Blackheath Football Club Ltd, and agree to abide by the Club rules. I enclose a cheque made payable to Blackheath Football Club Ltd for Signature..Date.. Data Protection Act: Members wishing to verify their computer details should contact the Membership Office at the address shown above Women Players: please contact Aisling Hogan at Blackheath Rugby, The Rectory Field, Charlton Rd, Blackheath, London SE3 8SR m 07961 577433 or email blackheathwomen@googlemail.com For other Club details please tick Lottery details..Development Fund Details.. &,HIkyW X ʲjjjjb^bC5hc8h0JB*CJOJQJ^JaJmH phsH h \jh \U+hmB*CJOJQJ^JaJmH phsH 1hc8hB*CJOJQJ^JaJmH phsH 1hc8hB*CJOJQJ^JaJmH phsH /hc8h5B*OJQJ\^JmH phsH 1hc8hB*CJOJQJ^JaJmH phsH 7hc8h5B*CJOJQJ\^JaJmH phsH ,I #  & C  q r $a$gdadhgdcHf  8 dhgdcHf $dh*$a$gdcHf $d*$a$gdm $d*$a$gdm $d*$a$gdcHf $*$a$gd$a$gd  " # Q ʵjQj;j+hUAGB*CJOJQJ^JaJmH phsH 1h)hKS`B*CJOJQJ^JaJmH phsH 1h)hB*CJOJQJ^JaJmH phsH 1h)hyrB*CJOJQJ^JaJmH phsH 1h)hB*CJOJQJ^JaJmH phsH )hc8hB*OJQJ^JmH phsH 1hc8hB*CJOJQJ^JaJmH phsH 8jh \0JB*CJOJQJU^JaJmH phsH  Q R \ {  % & 3 N ͷ͞͞oYCC+hcHfB*CJOJQJ^JaJmH phsH +hUAGB*CJOJQJ^JaJmH phsH 1h)hmB*CJOJQJ^JaJmH phsH +hB*CJOJQJ^JaJmH phsH 1h)hKS`B*CJOJQJ^JaJmH phsH +h)B*CJOJQJ^JaJmH phsH 1h)hB*CJOJQJ^JaJmH phsH 1h)h)B*CJOJQJ^JaJmH phsH  ( * , - 9 : ; B C ʹ枃jT;1h)haB*CJOJQJ^JaJmH phsH +hB*CJOJQJ^JaJmH phsH 1h)h)B*CJOJQJ^JaJmH phsH 4hcHfhcHfB*CJH*OJQJ^JaJmH phsH +hcHfB*CJOJQJ^JaJmH phsH 1h)hB*CJOJQJ^JaJmH phsH 1h)h B*CJOJQJ^JaJmH phsH 1h)hB*CJOJQJ^JaJmH phsH  r '(/зrY=r7h)h5B*CJOJQJ\^JaJmH phsH 1hf5B*CJOJQJ\^JaJmH phsH +hUAGB*CJOJQJ^JaJmH phsH +hcHfB*CJOJQJ^JaJmH phsH 1h)hB*CJOJQJ^JaJmH phsH 1h)hB*CJOJQJ^JaJmH phsH 1h)haB*CJOJQJ^JaJmH phsH +haB*CJOJQJ^JaJmH phsH r [\o%&Hgdhgd $*$a$gd) $da$gdf $da$gdf $dh*$a$gdf $dha$gdUAG$a$gddhgdUAG/Z[\㮏pW;";1h)hB*CJOJQJ^JaJmH phsH 7h)h5B*CJOJQJ\^JaJmH phsH 1hcHf5B*CJOJQJ\^JaJmH phsH =h)hKS`56B*CJOJQJ\]^JaJmH phsH =h)h56B*CJOJQJ\]^JaJmH phsH 7h)hKS`6B*CJOJQJ]^JaJmH phsH 1hcHf6B*CJOJQJ]^JaJmH phsH 7h)h6B*CJOJQJ]^JaJmH phsH  /㮕ǕvǮ`GǮ`1hh5B*CJOJQJ\^JaJmH phsH +hfB*CJOJQJ^JaJmH phsH =h)h56B*CJOJQJ\]^JaJmH phsH 1hf5B*CJOJQJ\^JaJmH phsH 1h)hB*CJOJQJ^JaJmH phsH 7h)h5B*CJOJQJ\^JaJmH phsH 7h)hKS`5B*CJOJQJ\^JaJmH phsH cefnx%&4噀dK05h)h)@B*CJOJQJ^JaJmH phsH 1h)h)B*CJOJQJ^JaJmH phsH 7h)h)5B*CJOJQJ\^JaJmH phsH 1ha5B*CJOJQJ\^JaJmH phsH 1h)hB*CJOJQJ^JaJmH phsH 4hfhKS`5B*CJOJQJ^JaJmH phsH .hf5B*CJOJQJ^JaJmH phsH 4hfh5B*CJOJQJ^JaJmH phsH  GHwe"hfCJOJQJ^JaJmH sH (h)hfCJOJQJ^JaJmH sH 1hh5B*CJOJQJ\^JaJmH phsH 7h)hf5B*CJOJQJ\^JaJmH phsH h)CJaJ1h)h)B*CJOJQJ^JaJmH phsH 9h)h)@B*CJOJQJRH`^JaJmH phsH 10:p \. 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