BGA Membership Application Form

Name^* _________________________________________

Telephone _________________________________________

Address _________________________________________

_________________________________________

Post code _________________________________________

Email _________________________________________

Grade (if known) ________ kyu / dan

Club (if any) _________________________________________

I heard of the BGA from _________________________________________

I wish to join the BGA for _____ years at £________ per year.
(Concessions please specify:
❏ under-18
❏ under-26 full-time student at a UK approved educational establishment
❏ receiving an unemployment or disability benefit, please state which one
❏ over State retirement age.)

❏ I enclose a donation of £________ for outreach and promotional purposes.

❏ Please allow other Go players to be given my name to help the formation of new clubs.

I would like to receive the newsletter ❏ by email ❏ in the post. (Email is preferred.)

I agree that the BGA may keep a record of this information, on the understanding
that it will not be passed on to any other organisation, except as required by law.

Signed _________________________________ Date __________________

^* Under-18s: please give your date of birth too.
Families: please give the details of all family members. Use the back of the form if necessary.

Last updated 16th April 2010

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