Please print off and submit
BHAA MIDLETON COLLECTIVE TEAM Membership Application Form 2024
Employer: _MIDLETON COLLECTIVE
Address: THE LODGE,
___________________________________________
Team Secretary:_Edmond O’Sullivan
Address:__8 Roxboro Close, Midleton, P25YK20
Mobile: 086/8323267
Applicants
Name:______________________________
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 2024. 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.
Team Membership fee of €15 (full annual 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 or kevcummins@eircom.net
