MEMBERSHIP APPLICATION FORM
Reference no:______________________

Please write in CAPITALS

Adult Fee 80.00 + 20.00 joining fee  2005-06
Junior Fee 20.00 (no joining fee)  2005-06

Full Name_____________________________________________________________
Date of Birth___________________________________________________________
Address_______________________________________________________________
______________________________________________________________________
________________________________________Post Code______________________
Phone no Home__________________________________________________________
Phone no Mobile_________________________________________________________
Vehicle Registration No___________________________________________________
Existing BASC No_______________________________________________________
Expiry Date_____________________________________________________________
Shotgun Cert. No_________________________________________________________
Expiry Date______________________________________________________________
Issued By_________________________________________Police Firearms Department

Question 1
Have you had any legal action taken against you for firearms or poaching offences?
Yes/No If yes, give details.

Question 2
Have you had BASC membership refused?
Yes/No If yes, give details.

Question 3
Do you own a suitable dog?
Yes/No If yes, give details.

I hereby apply for membership of the Pembrokeshire Wildfowlers Association and, if accepted, agree to abide by the current rules of the club.

I authorise the Association Secretary and Treasurer to store my personal details (name, address & phone number) on computer disk, solely for record purposes.

Applicants Signature:______________________________________________________

PLEASE GIVE DETAILS ON THE REVERSE OF THIS FORM OF YOUR SHOOTING EXPERIENCE AND MAIN INTERESTS