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HASSRA MEMBERSHIP APPLICATION FORM |
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Mr |
Mrs |
Miss |
Ms |
Other (please specify) |
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Surname |
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First name(s) |
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Employer details |
DWP |
DH |
FSA |
Contractor |
Retired |
Special hospital | |||||||||||||||||||||||||||||||||||||||||||||||
Business Unit |
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Office Courier Address |
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Staff no./Payroll no. |
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Date of Birth |
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National Insurance No. |
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Room no. /Section |
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Home Address |
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Postcode |
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Daytime telephone no. |
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Email (home or work) |
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For Official use only | |||||||||||||
Date Payform completed |
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Date Membership card Issued |
Card no. |
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Which of these activities or sports are you interested in? | |||||||
Amateur Dramatics |
Cycling |
Netball |
Skiing | ||||
Angling |
Dancing |
Orienteering |
Snooker | ||||
Archery |
Darts |
Paintballing |
Squash | ||||
Art |
Discount offers |
Photography |
Swimming | ||||
Athletics |
Equestrian |
Pool |
Table Tennis | ||||
Badminton |
Flat Green Bowls |
Putting |
Tai Chi | ||||
Basketball |
Football |
Quizzes |
Telly addicts | ||||
Chess |
Golf |
Rifle Shooting |
Ten Pin Bowling | ||||
Cinema |
Gym |
Rounders |
Tennis | ||||
Clay Pigeon |
Handicrafts |
Rowing |
Theatre | ||||
Climbing |
Hockey |
Rugby |
Triathlon | ||||
Coach Trips |
Holidays |
Sailing |
Volleyball | ||||
Cricket |
Literary |
Scrabble |
Walking | ||||
Croquet |
Martial Arts |
Shooting |
Wine tasting | ||||
Crown Green Bowls |
Music |
Short Breaks |
Yoga | ||||
Are there any other activities you like to do, or would like to try – state which:
Volunteering |
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Are you a qualified official in any of these sports or activities? If so, state which ones: | ||||||||
Would you like to be a volunteer in the HASSRA community – tell us what you are interested in doing or if you would prefer to find out more opportunities first | ||||||||
As an events organiser |
As an umpire | |||||||
As a business sponsor |
Possibly interested, but want to know more | |||||||
I hereby authorise the deduction of £1.50 per month from my salary or pension as soon as possible until further instruction. I declare that I am working for (or retired from) the DWP, DH, FSA, one of their Executive agencies, a special Hospital or employed by a private contractor on a Departmental contract. | ||||||||
Signed |
Date |
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