Finn Valley A.C. Membership Form 2004 – 2005

Annual Club Membership Now Due

Please complete & return to the Registrar with the relevant fee.

Membership not effective until full fee is received.

Thank You –

Grainne Mc Gowan, Club Registrar

Name ………………………………………………………………

Address …………………………………………………………….

……………………………………………………………………..

Telephone Number ………………………….

D.O.B ………………………………………

Category ……………………………………..

E.mail …………………………………………

Family Membership

1^st Child Name …………………………D.O.B…………………

2nd Child Name ………………………..D.O.B…………………

3rd Child Name …………………………D.O.B…………………

4th Child Name …………………………D.O.B…………………

Details of any Health Problem………………………………………

………………………………………………………………………

Signed ………………………………………………….

Juvenile ……………………………………….. €35

Senior Membership ……………………………………….. €80

Family Membership ……………………………………….. €100

Working Member of Family……………………………………….. €80

Weights Room Membership ……………………………………….. 8080 $€80