Membership Application Form 2012/2013
Please print this form and fill in where appropriate.
Note! the CALPAC Membership runs from 1st April till 31st March
No joining fee for Juniors & Intermediates.
For existing members only you must put your existing membership Nº here (...............)*
Existing FULL members do not require joining fee
*NEW Membership / Renewal of existing membership (delete which is applicable)*Block capitals please. * Obligatory
*NAME (Mr/Mrs/Miss/Ms)....................................................
*ADDRESS............................................................................
...........................................................................................
...........................................................................................
...........................................................................................
*POSTCODE...........................................................................
*TEL No / Mobile Nº................................................................
*Email address......................................................................
*TYPE OF MEMBERSHIP...........................................................
*Reg No. (if disabled).............................................................
*Date of birth .......................................................................
X......................................................................................X
Signature of Senior Member or Parent responsible for Junior Member.
Juniors under the age of 12 must be accompanied by an adult when fishing.
Fishery Key....... Badge.......(Please tick if required)
I wish to become a Member of C.A.L.P.A.C for 2012/2013 season and agree to
abide by their rules contained in the Guidebook, in the knowledge that any breach of the rules
could lead to my Membership being cancelled. I also agree that C.A.L.P.A.C.
or any of its representatives will not be held responsible for any loss, damage or injury whatsoever.
A £20.00 joining fee must accompany this form (Except Existing FULL Members, Juniors & Intermediates), along with the fee for the type of membership and any items you wish to purchase.
I enclose cheque/postal order for the sum of £......................
Cheques/Postal Orders to be crossed and made payable to CALPAC
Signed.............................................................................Date.........................................
Return this form to Mr J Bygrave, 419 Wickham Road, Shirley, Croydon CR0 8DP
Can you tell us where you heard of CALPAC.................................................................
