New Membership Application Form

For new membership applications only, please fill in the form below and then print out and send with your payment to:
Jean Fairbanks, P.O. Box 6486, Ferndown, BH22 2AZ

Please provide the following contact information:

Title:
First Name:
Middle Initial:
Last Name:
Address 1:
Address 2:
Town:
County:
PostCode:
Country:
Home Phone:
E-mail:
Car Reg. No.
   
  If the applicant is a Junior then please include Date of Birth below:
Junior Date of Birth:

Select any of the following options that apply:
Joining Fee  £20.00     Junior Under 18 £50.00 ( No joining fee )  
Adult £130.00     Junior Under 12 £7.00 ( Date of Birth required )  
Senior Citizen £83.00     Disabled * £83.00 ( * Evidence of disability required )  
* Disabled applicants should provide documentary evidence of their disability ( Photocopy)
             
Select any of the following options that apply:
Night Permit   £32.00  
Third Rod £30.00  
Non Fishing Guest £10.00  
Total amount enclosed  £ 

Choose one of the following options:  (If paying by  credit card please fill in your card number by hand before sending)

  ( Please make cheques / postal orders payable to RDAA )

Credit card no:
Expiry Date:
Card Holder:

Office use:  Permit No..............Expiry
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