Northmiddlesexreferees.org.uk

ORTH MIDDLESEX REFEREES SOCIETY
Membership ApplicationForm Season 2013/2014
ame:- .
Home Address:- .
Telephone:- (Home) .
(Office) .
(Mobile) .
E-Mail Address:- .
Date of Birth:- .
First Registered:- .
*Parent County FA:- .
** PD umber:- .
First Joined MRS:- .
*If you have not registered with the FA this Season, please state O E as we now have to advise this information on our remittance to the RA
** If you have registered with the FA this season, your PD umber is available from your Receipt
Are You Applying for Promotion:-
*Level:- .
Are You an 'Active' Referee:- Yes/No
( otwithstanding your registation Level (1 to 10), please also indicate above if you are an Assessor(A); Examinor(E); Instructor(I); or
Mentor(M). Please state all that are applicable as we now have to advise on our remittance to the RA)
Do You hold any other positions in Football? ie Referees Secretary; League Officer:- .
.
ame of any other Society of which you are a Member:- .
Please note any Long Service Awards you have received for Refereeing:- .
Would you be interested in being placed in a Draw for an FA Cup Final Ticket if the Society receives an
allocation:- Yes/ o Team Supported:- .
Would like to receive your ' ormidian' by E-Mail rather than by post; please indicate:-
Please Send this Form with Remittance to:- Gary Cobden, 2 Chapel End, Hoddesdon, Hertfordshire, E 11 8D .
Telephone 01992 469153. Cheques should be made payable to orth Middlesex Referees Society. In the event of a
change of address during the Season, Please advise Gary Cobden.
Membership Category:-
Full Membership If you have a valid E-mail address and
Amounts Due:-
choose to receive your Magazine this
way, you may reduce your Society
Society Membership Fee:-
£ 6.75 Membership Fee by £1.25 to £5.50; if
Referees Association Fee :-
£16.00 you are a new member, the RA Fee may
Sub - Total:-
Minimum Amount Due £22.75 be reduced to £10.00.
Donation To Society Funds:-
100 Club Membership/Renewal £12.00 per share per season:-
R. A. Physiontherapy cover at £25.00 or £35.00 per season:-
Birthday Cards at £2.00 per pack of twelve:-
I Enclose:-
Subscriptions fall due Annually on 1 April. or on joining or rejoining the Society. To ensure your RA Insurance
runs continuously to cover your End Of Season and Pre Season games you should renew now.
Please indicate below any suggestions for possible Social Activities during the forthcoming Season:-
.
.
You have previously indicated an interest in the following Events which may be run during the Season.
Quiz ight:- Yes/ o Race ight:- Yes/ o End of Season Function:- Yes/ o
The details on this Form will be transferred to the Society Computer Records.
The Data Protection Act 1998: As an unincorporated Society with computerised records relating only to members for
mailing and accounting purposes, the Society is exempt from registering under the Data Protection Act, providing members
do not object. The records held are not disclosed to any third party or other members of the Society. If you object please
contact the Society Secretary.
I agree to abide by the Society Rules, and confirm the details shown above - as amended - are correct:
Signature

Source: http://www.northmiddlesexreferees.org.uk/documents/membform_adult_part.pdf