Finn Valley Athletic Club.

Application for Membership 2007 -2008

Please complete & return to reception with the relevant fee.

Membership is not effective until full fee is paid.

Name: __________________________________

Address: ________________________________________

EMAIL/Telephone No: _____________________ Date of Birth: ______________________

Category:

JUVENILE MEMBERSHIP € 40.00

SENIOR MEMBERSHIP €100.00

FAMILY MEMBERSHIP €125.00

Family Membership

1^st Child ____________ DOB ___________ 2^nd Child __________ DOB __________

3^rd Child ____________ DOB ___________ 4^th Child __________ DOB __________

Details of any Health Problems: __________________________________________

Signed: _______________________________________

For Office Use Only.

Membership Proposed by: ______________________________

Seconded by: _______________________________

Amount Received: ________________________________

Received By: ____________________ Date: ________________

MEMBERSHIP NO: ____________________ Expiry Date: _______________