Membership Form If you are human, leave this field blank.Page BreakMEMBERSHIP DETAILSMembership Application *Are you joining for the first time or are you renewing your club membership? i.e. have you been a registered member of RLSS Poole Lifeguard in the past? NEW MEMBERSHIP RENEWALMembership Number *This is the Membership Number shown on your renewal slip. If you do not know your Membership Number then send an email to membership@rlss-poole.org.uk requesting it. If you are joining for the first time then select "New Membership"Membership Year *Select the year that you are applying for club membership - Membership year is 1st Jan to 31st Dec2022Membership Type *Individual MembershipFamily MembershipMembership Fee *Full Year Membership if applying between 01st Jan and 31st AugHalf Year Membership if applying between 01st Sep to 31st DecCategory *Those under 18years of age on 1st Jan are Juniors for that year.Senior - full year £45Junior - full year £35Supporter - full year £25Life Member - full yearGuest Member £5Family Membership Fee (Full Year) *Those under 18years of age on 1st Jan are Juniors for that year.Family Membership Full Year - full year £80Part of Family Membership - £00.01Category *Those under 18years of age on 1st Jan are Juniors for that year.Junior Family MemberSenior Family MemberSupporter Family MemberCategory *Those under 18years of age on 1st Jan are Juniors for that year.Senior - 01st Sep - 31st DecJunior - 01st Sep - 31st Dec Supporter - 01st Sep - 31st DecGuest - 01st Sep - 31st Dec Family Members *List the name of the applicant who has paid the "Family Memership" fee.Family Members *List the names of your familly members to be included in the "Family Memership" fee. Remember to complete a membership form for each family member. Page BreakFREE CLUB T-SHIRTAnybody joining our club for the first time is entitled to a free RLSS Poole Lifeguard Club T-shirt. Therefore please select the 'Style of Tshirt' followed by the 'Size' you would like. T-Shirt Style *Junior T-Shirt - Age 9 -16Senior T-Shirt - Age 17 upwardsT-Shirt Size *SM - Chest 37inMD - Chest 40inLG - Chest 43inXL - Chest 46inXXL - Chest 48inNo Thank You!Junior T-Shirt Size *SM Chest 28inMD Chest 30inLG Chest 33inXL Chest 35inNo Thank You! MEMBER DETAILSName *Address *CountryUnited States (US)United Kingdom (UK)CanadaAustralia---AfghanistanÅland IslandsAlbaniaAlgeriaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAmerican SamoaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelauBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraÇaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqRepublic of IrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalQatarReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Martin (Dutch part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSan MarinoSão Tomé and PríncipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaWestern SamoaYemenZambiaZimbabweCityStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces (AA)Armed Forces (AE)Armed Forces (AP)American SamoaGuamNorthern Mariana IslandsPuerto RicoUS Minor Outlying IslandsUS Virgin IslandsZip codeE-mail address *Confirm Email AddressHome PhoneEx-Dir (Home)YesMobile Phone No. *Confirm Mobile No.Ex-Dir (Mobile)YesDate of Birth *Age *Age on the 1st January for the year that you are paying your membership fee. Medical Ailments *Do you have you any medical ailments that we as a club should be aware of? NoYesAilment Details *If your answer is \'YES\' please enter details of your ailments (Confidentiality will prevail) Please also note: that it is your responsibility, to update RLSS Poole Lifeguard of any ailments should your circumstances change during the year!Notify UsDo you agree to update RLSS Poole Lifeguard, should your circumstances change, during the membership year!I agree to update RLSS Poole of changes Page BreakDISCLAIMERS1) I the undersigned apply for membership of RLSS Poole Lifeguard 2) I agree to abide by the Constitution and Rules of the Club (copies may be obtained from the Hon Secretary on request). 3) I understand that the Club is fully committed to safeguarding the well-being of all its members, particularly children, and that all member are expected to show respect and understanding for the rights, safety and welfare of others, and conduct themselves in a way which reflects the principles of the Royal Life Saving Society UK. 4) I also understand that my membership is renewable on an annual basis, and that it will be due, during the month of December, for the following calendar year.Club Disclaimer *I Understand and AgreeI dont agreeNon Agreement *Please enter what you do not agree with, and we will get in contact with you and discuss whether we can continue to process your application for club membership. Be assured that confidentiality will prevail. Please note: that if you select "No I don't Agree" and do not enter the reasons in this field, your membership application will not be processed. PUBLICITY PHOTOSOn occasions we take photographs of our club members and their activities / achievements for use as publicity/promotions for the club and it’s aims. Do you give permission for photographs that may contain images of you, or your child, to be used for such purposes, eg on our club noticeboard, website, social media and or press to promote the clubs activities.Photos *I give permissionI do not give permission I give permission so long as the identity is obscured CRIMINAL OFFENCES6) Applicants are advised that under regulations made under the Rehabilitation of Offenders Act 1974, you should declare all relevant matters including \'spent convictions\'. This however does not include speeding, careless driving, depositing of litter or other matters which might reasonably be regarded as minor. If in doubt, please speak in confidence to the Chairman/Hon Secretary before answering this question. This information is required because as a trainee Lifesaver/Lifeguard you will be working with children and young people).Offences *Have you ever been convicted of a criminal offence or been the subject of a caution or a bind-over order?NoYesNotify UsYou agree to update RLSS Poole Lifeguard, should this change, during the membership year!I agree to notify PLG of any releavent changes.Details Of Offence(s) *Please state the nature and dates of the offence(s). GIFT AIDTax Payer *Are you a registered tax payer ?YesNoGift Aid *Have you filled in the Gift Aid Form? YesNoGift Aid Detailsby completing a Gift Aid Form it allows the club to claim money on your donation for the club membership fee. PERSONAL DATAAs part of your membership application, the club will add your details to our club database. These details are used solely for club purpose and are not given out to third parties. Your details are used to communicate the occasional club notice and or club E-Newsletter to you. On receipt of the E-Newsletter you will have the option to unsubscribe from it should you so wish.Personal Data *I understandDate of Application *todays date DECLARATIONDo you declare that the information that you are about to submit in this online form is correct and true.Declaration *I declare the above info is trueMember Signature *Entering your name electronically is acceptable.Parent or GuardianName of Parent or Guardian if applicant is under 18 years old.Parent or Guardian EmailConfirm Parent or Guardian EmailParent or Guardian Tele No. * FORM SUBMISSIONDo you declare that the information that you are about to submit in this online form is correct and true.Many thanks for taking the time to complete this form. NOW Press the SUBMIT button ONCE and then wait for the PayPal screen to appear to enable you to make payment and complete your membership application. NOTE: If the PayPal screen does not appear, follow the link below to make a manual payment.  https://www.rlss-poole.org.uk/?p=5425 Captcha *For security verification, please enter any random two digit number. For example: 45Submit Form