BEWSA MEMBERSHIP FORM

TYPES OF MEMBERSHIP

FULL MEMBERSHIP: Open to Disabled Service and ex-service personel ( incl. Reserve Forces and Territorial’s )

ORDINARY MEMBERSHIP: Open to Serving and Ex-serving Able bodied personnel ( incl. Reserve Forces and Territorial’s )

ASSOCIATE MEMBERSHIP: Open to people who do not comply with above.

September 2008/9 Subscription Fees.

The Royal British Legion, £11.00. BEWSA £2.50.

Dive Branch BSAC 2000. £36.00 per Year, Plus BSAC Subscription

Total_____________ Please make cheques payable to BEWSA

PERSONAL DETAILS Email:

Title/Rank/Style: Surname: Forenames:

Marital Status: Sex: Date of Birth:

Address:

Post Code:

Telephone No. Day: Evening: Mobile:

SERVICE DETAILS

Branch of Service ( R.N./ARMY/R.A.F./R.M.) Regiment/Corps:

Last Unit/Establishment Served: Rank/Rate:

Service Number: Date Enlisted: Date Discharged:

War Pensioner: € Yes € No

TYPE OF MEMBERSHIP: FULL/ORDINARY/ASSOCIATE (PLEASE CIRCLE MEMBERSHIP APPLIED FOR)

SIGNATURE:…………………………………….. DATE:…………………………………………

FOR FULL MEMBERSHIP

Nature of Disability: (Tetra (complete, incomplete)/Para (complete, incomplete) /Amputee/Other please give FULL details:

Continue overleaf if necessary

Level/Description of Injury: (T?/C?/L?, A/K B/K) Date of onset of disability.

Sports Classification if Known: Preferred Sports:

FOR FULL/ORDINARY MEMBERSHIP (New Members Only)

PLEASE ENCLOSE A COPY OF YOUR SERVICE/DISCHARGE

FOR OFFICIAL USE ONLY

Date Received………………… Subscription Fee Enclosed: Yes/No

Date Approved/Not Approved by Executive/Branch Meeting………………………………………………….

Membership Number……………………………………. I.D. Card Issued Yes/No Date…………………

Please send to: Mr RJ Simmons, 15 Third Ave, Blyth, Northumberland, NE24 2SA