Secretary Lyn Walmsley. Gwelfryn, Brynford Common, Nr. Holywell, Flintshire, CH8 8AH Tel. no. 01352 710057
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MEMBERSHIP APPLICATION FORM 2012-2013
Membership last for one year and runs from January 1st to December 31st
Joining in October – December covers membership for the next complete year
Membership is only available for persons aged 12 years and over in the currant year.
1st Member
Name:________________________________
2ndMember
Name:_________________________________
I have previously competed in driving trials and do not require assessment. Please enclose a
brief driving history or copy of your assessment form.
I have never competed in driving trials and request assessment so I can compete in future events.
Membership Fees 2012-2013
CHTDG
Membership
Fee
BHDTA
Insurance
Fee
BHDA
Administration
Fee
Total
Payable
Single Member who is also BHDTA
Member
Single Member non BHDTA Member
£26.75
£8.25
n/a
£35.00
£26.75
£8.25
£9.00
£44.00
Couple Members where both are BHDTA
Members
Couple Members where one is BHDTA
Member
Couple Members neither is BHDTA
Member
Associate Member
£38.50
£16.50
n/a
£55.00
£38.50
£16.50
£9.00
£64.00
£38.50
£16.50
£18.00
£73.00
£5.00
n/a
n/a
£5.00
Please
Tick
BHDTA Administration Fee is not payable by Full/Associate or Club BHDTA members
Please provide BHDTA Membership number(s) if applicable.
First Member _______________________
Second Member __________________________
Directors: C. Walmsley; H. Jones; S. Massey; G. Benest
Secretary: L.Walmsley
Treasurer: E. Hart
Subscription Enclosed: £_______________
Cheques payable to CHDTG
If you have not paid your BHDTA subscription your BHDTA number must be provided prior
to entering any CHDTG event. Please Email [email protected] or Tel: 01352 710057
ADDRESS
___________________________________________________________________
_________________________________________________________
_________________________________________________________
POST CODE _______________ HOME TELEPHONE NUMBER ________________________
MOBILE NUMBER(S) 1)_______________________ 2) _________________________________
E-MAIL ADDRESS (Please print clearly)
_________________________________________________________________________________
You are asked to note the following statement in connection with the data protection Act:
Any data or information provided to CHDTG for the purpose of membership and other CHDTG activities will
be processed by means of a computer database or otherwise. We will not share your information with anyone
other that CHDTG members. If you would prefer that other members are not given your contact information
please tick here
SIGNED: _______________________________ DATE:___________________
SIGNED : ______________________________ DATE:____________________
(2nd Member)