For those of you wishing to join the BHAA Team.

BHAA Membership Application Form

 

Employer: _MIDLETON TOWN COUNCIL

Address: THE LODGE, YOUGHAL ROAD, MIDLETON.

___________________________________________

Team Secretary:_Edmond O’Sullivan

Address:__Glaramara, Suncourt, Midleton.

Contact Telephone Number:__086/8323267

 

Applicants Name:______________________________

Applicants Address:_____________________________

_____________________________________________

 

Telephone Number: (home)________ (work)_021/4632901

 

Date of Birth:______________

 

 

Category:( please tick) Ladies_____Men_____

Veteran    0/35....   0/40....   0/45....   0/50....   0/55....   0/60....   0/65....   0/70....

 

I __________________wish to apply for full membership of the Business Houses Athletic Association for the membership year 2019.  I confirm that I am an employee of the above named employer. In applying for membership, I agree to be bound by the rules of the Business Houses Athletic Association.

Membership fee of €10 (full membership) is enclosed.

 

Cheques & Postal orders should be made payable to Cork BHAA (Please do not send cash through the post).

 

Signature_______________________

 

Date __________________________

 

 

Note: The Business Houses Athletic Association reserves the right to obtain confirmation of employment.

 

Please send the completed form and cheque or postal order( NO CASH) to -

Kevin Cummins,  24, Ashleigh Drive,  Skehard Road,  Blackrock,  Cork       Telephone: (021) 429 2509 (021) 429 2509      kevcummins@eircom.net