Name: (*)

Address: (*)

Phone number: (*)

Email address: (*)

Date of Birth (if under 18 years):

Vehicle Reg. No.:


Section: (*)
A Senior  A Junior  B Senior  B Junior 
If the ‘A’ Section is full, do you wish to join the ‘B’ Section? : (*) Yes No

Name of Proposer:                                        Name of Seconder:
  

Are you a member of any other angling club(s)? : (*) Yes No

If Yes, state which :
Are you a club official or committee member? : (*) Yes No

Have you ever been expelled from or been refused membership of any angling club? : (*) Yes No
If Yes, please give details :


Do you hold a current ATDAC membership card? : (*) Yes No
If Yes, which club issued it? :


By submitting this application, you agree to comply with the rules of Stockton Angling Limited