Club & Coaches registration forms

28/3/2009 - 27/3/2010

 

2009 FORM FOR IBF/BCSA CLUB MEMBERSHIP &  PL  INSURANCE

                      All questions to be completed fully in block capitals. All officials must be registered with the Criminal Records Bureau (forms available from HQ)

                    Please complete in BLOCK CAPITALS (eligible form will be returned)

CLUB NAME

 

VENUE ADDRESS

 

ADDRESS

 

TOWN

 

COUNTY

 

POST CODE

 

SECRTARY

 

ADDRESS

 

ADDRESS

 

TOWN

 

COUNTY

 

POST CODE

 

E.MAIL

 

TEL NO

 

FAX NO

 

INSTRUCTOR

 

 

 

 

 

 

 

 

Renewal Date 28/3/2010

LIMIT OF INDEMNITY £5,000,000

 Please Note : Insurance will not commence until a correctly completed  and signed proposal form and your cheque is received by our insurance broker Worldwide Sports Insurance Uk Ltd . All cover is subject to the terms, conditions and exceptions of the master policy held by our broker and is available for inspection upon request. Please read the following declaration, sign at the bottom and return this form, together with your cheque. Fee £50

Declaration: I declare that to the best of my knowledge and belief there are no known incidents or circumstances that might give rise to a claim

 

  Signed    ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. Date ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .

You can pay over the internet via Internet Banking or Paypal contact HQ for further details

 

 

 

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FORM FOR IBF/BCSA COACHES/INSTRUCTORS REGISTRATION

March 28th 2009 Fee £80

All questions to be completed fully in block capitals. All Coaches/Instructors must be registered with the Criminal Records Bureau (forms available from HQ) Please complete in BLOCK CAPITALS (eligible form will be returned)

 Limit of Indemnity £2 million

NAME

 

STREET

 

STREET

 

TOWN

 

COUNTY

 

POST CODE

 

COUNTRY

 

D O B

 

TEL: NO:

 

MOBILE NO:

 

FAX NO:

 

E.MAIL ADDRESS

 

MARTIAL ART

 

GRADE

 

QUALIFICATION

 

CLUB

 

Please Note : Insurance will not commence until a correctly completed  and signed proposal form and your cheque is received by our insurance broker Worldwide Sports Insurance Uk Ltd . All cover is subject to the terms, conditions and exceptions of the master policy held by our broker and is available for inspection upon request. Please read the following declaration, sign at the bottom and return this form, together with your cheque.

Declaration: I declare that to the best of my knowledge and belief there are no known incidents or circumstances that might give rise to a claim.  

 

 Signed    ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. Date ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .

You can pay over the internet via Internet Banking or Paypal contact HQ for further details