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)
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CLUB NAME |
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VENUE ADDRESS |
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ADDRESS |
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TOWN |
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COUNTY |
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POST CODE |
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SECRTARY |
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ADDRESS |
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ADDRESS |
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TOWN |
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COUNTY |
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POST CODE |
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E.MAIL |
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TEL NO |
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FAX NO |
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INSTRUCTOR |
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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
.
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
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NAME |
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STREET |
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STREET |
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TOWN |
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COUNTY |
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POST
CODE |
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COUNTRY |
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D O B
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TEL:
NO: |
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MOBILE
NO: |
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FAX
NO: |
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E.MAIL
ADDRESS |
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MARTIAL
ART |
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GRADE |
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QUALIFICATION |
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CLUB |
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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