North West Balloon and Airship Club

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Application for Membership

Please print, complete, and return with your cheque made payable to NWBAC to:

Derek Grimshaw,
Fleetwood Farm,
North Road,
Bretherton,
Leyland
PR26 9AY

or, Transfer via internet banking to:- NWBAC
Sort Code:- 77-76-08
Account Number:- 36241760


Name:
Address:
Postcode:
Home tel:
Business tel:
Mobile:
Email: 
Balloon Type:
Manufacturer:
Size/Type:
Artwork:
Colours:
Ballooon Name:


Type of Membership requested: Single (£12 p.a.) Family(£15 p.a.)

Type of Pilots Licence: PPL CPL PUT

Available to Crew: Vehicle Driving Licence:

Membership Fee: Single - £12.00 annually; Family - £15.00 annually



Data Protection Act: Please note the above information will be stored on computer, if you have any objection to this please state