WBU MEMBERSHIP APPLICATION THIS FORM SHOULD ONLY BE USED IF APPLYING FOR NEW WBU MEMBERSHIP Personal Details First Name* Last Name* Male/Female MaleFemaleNot Supplied D.O.B Address* Telephone (Home/Mob) Email Affiliation Details Primary Club (if applicable, the Club must be affiliated to the WBU) ---AberaeronAbergavennyAberystwythArchway (Ch)BarrivaleBridgendBreconCardiffCardiganCarmarthenCastle (Welshpool)Colwyn BayCowbridge (Old Hall)CricciethCrickhowellDinas & NewportGwent AcademyHaverfordwestKnightonLampeterLetterstonLisvaneLlandudnoLlanelliLlanfairfechanMenai (ABC)Merlins BridgeMid GlamorganMoldMonmouthNewtownPark ViewPembrokePenarthPencoedPenrhyndeudraethPort TalbotPorthcawlPwllheliRhayader & LlandrindodRhiwbinaSwanseaSullyTenbyVale Of GlamorganWrexhamYnys Mon Please state if you are a member of another home union ---EBUSBUNIBUCBAI ....and provide any alternative NBO number Please choose who should administer your Master Point Account WBUEBUSBUNIBUCBAI Payment Details: Annual Membership (associated with a Club) - £10 Annual Direct Membership - £15 Junior - £1 Non-Direct Members are also required to register with at least one WBU Affiliated Area (this should be the Area of their Primary Club - see Area/Club List): East - £2.00 Mid - £2.00 North - £2.00 West - temporary concession Amount to Pay (WBU Membership + Area Fees)* £ (If this application is being requested by a third party - e.g. Club, please enter their name) The WBU holds your personal details for the purpose of administering your WBU Membership. In addition, occasionally we would like to send you information on news and events. Your personal details will not be divulged to a third party or similar (See WBU Privacy Policy). Please confirm that you accept* Pay with StripePay with Paypal
