SOTAS Application Form 2012

SOTAS Application Form 2012

Name in full _______________________________

Address __________________________________________________________________________

Postcode ________________

Date of Birth ___ / ____ / ____

Occupation ____________________________

Are you a member of any other Angling Clubs?; YES / NO * (If YES please give name of the other clubs, use separate sheet if necessary)

Have you ever been expelled, suspended or refused membership of any Angling Club? YES / NO * (If YES please give details, use separate sheet if necessary)
Which membership do you require? SENIOR CITIZEN/SENIOR/LADY/DISABLED/ JUVENILE Please delete as applicable.(Evidence of your entitlement to Disability Living Allowance at the Higher Rate for mobility reasons must accompany applications for membership as a DISABLED angler).

I agree to abide by the rules of the Stoke on Trent Angling Society and confirm that the above details are correct.Signature......................................................... Date ___ / ___ / ___

Applications to be sent to; Mr Mick Hann , 34 Kenley Avenue, Endon, Stoke-on-Trent, ST9 9HX; please enclose a stamped addressed envelope . Do not send any money with this application.

Under no circumstances will a telephoned application be accepted.  Please note that the 2012 subscriptions are SENIOR £55; LADY / SENIOR CITIZEN / DISABLED £30;JUVENILE age 12&13 £5 or age 14&15 £10.  There are no entrance fees in 2012.

Society waters: Stanley Reservoir, Rudyard Reservoir, R Sow Great Bridgeford, R Dove Fauld and Scropton, Knypersley Reservoir, Astbury Water Park.Bolesworth Castle (Closed) .Brooklyn Grange Fishery .RookeryPool.  North Road Pool.  Fly Fishing at Blithfield Reservoir booked in advance details in membership card.

Official Use Only
Accepted / Rejected. Date ___ / ___ / ___ Signature............................
Membership Offer letter sent ___ / ___ / ____ Ticket Number issued 12/________________