Application for Free Junior Ticket 
Aged Between 5 and 12 years on the 1st April Each Year
Please print one form and complete for each Junior Ticket Required. 
FULL YEARS FOC JUNIOR MEMBERS FORM ONLY                   (1st APR.2010 EXPIRES 31st Mar 2011)

RETURN TO
PRIOR PAGE
Name (In Full Please)
(Master/Miss)		  
Full Postal Address  
   
 
Telephone Number  
Date of Birth
 (Please Note the Rules regarding Age Range)		  
ADULT MEMBERS DETAILS (Associate or Affiliate) ARE REQUIRED
NAME OF CLUB
(If an Affiliate Member)		  
Membership Ticket No  
Name of Nominee
Address
   
 
PLEASE NOTE: 
JUNIORS - Over 5 but Under 12 years of age on the 1st April of each year.
When fishing on our waters must be accompanied by a Fully paid up Member (Associate or Affiliate) of the Association.
JUNIORS - Over 12 years of age, but under 16 years of Age on the 1st April of each year.
MUST apply for there own Membership Ticket.
(PLEASE USE THE OTHER MEMBERSHIP FORM FOR THIS PURPOSE)  ==  THANK YOU
Entry to Fisheries by Combination Lock -
Number will be supplied on ADULT'S Membership Ticket

Member/Club Secretary
 SIGNATURE ..................................................................................................

Parent/Guardian
SIGNATURE ..................................................................................................

DATE ..............................
REG. NO.............................................
                (OFFICE USE ONLY)
Please send to:
  
The London Anglers Association
Izaak Walton House,
2a Hervey Park Road
London
E17 6LJ
Tel/Fax 020-8520-7477