Republic of Ireland Soccer Supporters Club (London)
Membership Application Form
Season 2017 / 2018
Please clearly complete ALL sections using BLOCK CAPITALS
Surname:
First names:
Address:
Postcode:
Telephone:
Mobile:
Home:
email address:
@
Date of birth:
D D /
M M /
Y Y Y Y
Occupation:
COMPLETION OF THIS SECTION IS OPTIONAL
The composition of the membership of the club is expected to be made up of those who are Irish, are of Irish
descent or who have Irish connections (for example, by marriage) and you are asked to indicate which of the
following applies to you. Tick one box only:-
First generation (born in Ireland)
Second generation (one or
both parents born in Ireland)
Third generation (at least one
grandparent born in Ireland)
Other (Please specify)
Which League of Ireland
team do you support?
Members are expected to carry a valid passport when travelling to away games – either on organised club
trips or travelling independently – where match tickets have been obtained through the club.
Passport held:
Irish
British
Other (please specify)
Passport number:
I wish to apply for membership of the Republic of Ireland Soccer Supporters Club –
London Branch and agree to abide by the rules of the club.
Signed: ______________________________________
Date: __________________
Membership Fees
The following membership fees are payable and are dependant on when during the season when you apply.
The Club season runs from 1st July to 30th June the following year. If you join before 1st February, the
normal fee applies. If you join after 1st February, you pay for the remainder of the season and all of the
following season for a special reduced fee.
Normal Fee: (joining between 1st July 2017 and 1st February 2018)
Adult: £24/ €29 (email address supplied)
Child: £7.50/ €9.00
£29 / €35 (if you have not supplied an email address)
(under 16 years old)
Special Fee: (joining between 1st February 2018 and 30th June 2018)
Adult: £29/ €35 (email address supplied)
Child: £10.00/ €12.00
£33 / €40 (if you have not supplied an email address)
(under 16 years old)
Please return your application with the appropriate fee to the address below. Or you may personally hand it
in at a club meeting. Please do not send signed-for or registered post to the PO Box.
Remember:



Complete all sections of application form
Enclose one passport sized photograph (or separately send passport style photograph by email to
[email protected] quoting your name as reference)
Enclose a cheque or postal order for the correct fee (in sterling or euro), payable to RISSC - London.
Details of payment by e-banking available on request.
*** Do not send cash by post ***
Incomplete applications cannot be processed and will be returned. The committee reserves the right to;
(a) refuse membership (b) refuse to renew membership, or (c) suspend membership at any time.
Send to:
Please do not send signed-for or
registered post to the PO Box,
contact us first if intending to do so.
Membership Secretary
RISSC – London Branch
PO Box 475
Twickenham
TW1 9LD
Office Use only
Received:
£
/
-
Banked:
Card no.
Posted
/
Ref:
Cheque/ postal order/ cash
/
/
Issued:
/
/
Picked up at meeting