British Judo Association

Club Name

Club Number
(renewal only)

Club Venue


Postcode
Club Telephone Number

The club
is a

Registered charity

Limited company

Company limited by Guarantee

Club Internet Information (The information provided here will be publish on the BJA’s Web Site)
Contact name		Contact telephone
e-mail address		Club web site

Club Chairman		Club Secretary
Name		Name
Address		Address


Postcode
Telephone Number		Telephone Number
e-mail		e-mail
BJA licence Number		BJA Licence Number

Select one address for
correspondence

Club

Chairman

Secretary

Coaches (List any additional Coaches on a continuation sheet if needed)
Name	BJA Grade	BJA Licence Number



Club Official(s) (List any addition officials on a continuation sheet if needed)
Name	Position in Club	BJA Licence Number
	Treasurer

Club Practice Times
Day		Session start time	Session finish time





Approximate number of club members	Male	Senior	Junior
	Female	Senior	Junior

If accepted into membership of the British Judo Association, the Club agrees to abide by the Articles of Association and Bye-Laws, Child Protection Procedures and Equal Opportunities policy together with any amendments made during the period of membership.

I certify that to the best of my knowledge and belief, the information given in this application is correct.

The Club Chairman or Club Secretary can represent clubs at an AGM. Any other representative must be registered as a proxy in advance on the forms provided for that purpose prior to the AGM.

The British Judo Association is registered under the terms of the Data Protection Act and wishes to include the information you have provided on this application on the BJA database for the purpose of administration and maintenance of membership records, provision and administration of activities, support and fund raising. Complete the following section to indicate your consent to this process.

By submitting this form I consent to the information on this application being included on the BJA database.
Name of person submitting form		Date
Position in club

Note: Renewal application and fee must be forwarded to head office by 31 December. BJA Club membership and consequently insurance cover lapses on 1 January.