Club Membership
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
BJA Membership Number BJA Membership Number
Name Name
Address Address
   
   
Postcode  
Telephone
Number
Telephone
Number
e-mail e-mail
BJA Membership
Number

BJA Membership
Number


Select one address for
correspondence
Club Chairman Secretary

Coaches (List any additional Coaches on a continuation sheet if needed) - Your club must have at least one level 2 coach or above.
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 / Welfare Officer  

Club Practice Times
Day Session start time Session finish time
Approximate number of club members Male Senior Junior
Female Senior Junior


PAYMENT DETAILS Acceptable cards VISA/VISA ELECTRON/MASTERCARD/MAESTRO /SWITCH
CREDIT/DEBIT CARD NUMBER
CARD START DATE (mm/yy)
CARD EXPIRY DATE (mm/yy)
CARD HOLDERS NAME
ISSUE NUMBER (Switch Users Only)
CVV NUMBER (Last 3 numbers above the signature strip)
I confirm that I am the authorised card holder for the credit/debit card detailed above.
Please note that we are unable to accept American Express cards

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.