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Application form

BA CLUBS

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Lotteryba staff / staff retired

Monthly Annual

If paying by Payroll deduction, I authorise British Airways to deduct from my pay the Club subscriptionat the current rate agreed by the Trustees. I hereby declare that the information I have given is true andthat I agree to be bound by the Rules of the Club. Personal data provided by you will be held on computerfor the purpose of administration and will be used in accordance with the provisions of the DataProtection Act 1998. Please tick here if you do not wish to receive direct marketing from the Club

Complete this page, and the Direct Debit Instruction opposite, and send to Membership Admin, BA Clubs, Regus. 450 Bath Road. Longford. London. UB7 0EB.

Signature

AUthORiSAtiON

Date

Surname

APPlicANt detAilS

clUB MeMBeRShiP

First Name(s)

Mr Mrs Ms Other

Address

County Postcode

Staff No:

Date of Birth (dd/mm/yyy) Email

Telephone: Home Telephone: Mobile

ba staff /

staff retired

London Scotland

Newcastle South Wales

Regions

Gatwick

FemaleMale

BAMC BAAE BAIE

BActive GYM SUBScRiPtiON (NO BA clUBS MeMBeRShiP ReqUiRed)

Direct Debit: Annual Direct Debit: Monthly Payroll

Waterside Cargo The Link

MonthlyAnnual

Staff Spouse

PayrollDirect Debit

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