Membership Ref No.

HASSRA (Leeds) Associate Membership & Expressions Membership Form

PART 1 TYPE OF MEMBERSHIP - See notes. (Please circle): Type 1 Type 2 Type 3

I am eligible for membership because: (*Delete as appropriate)

*A). I am a contractor of DH/DWP (e.g. Trillium ,Group 4, Syntegra, GS Hall, Mitie etc)

*B). I work for an organisation on the approved list (e.g. NHS, Police, Fire service, WY Playhouse etc).

*C). I am a partner/immediate family/friend of/sponsored by Full/Associate HASSRA (Leeds) member e.g. someone employed or associated to DH/DWP

*D). I am applying for membership as part of a Community Group (Type 3).

Options A & B: MUST Complete Part 2, and state in full - (No abbreviation) which Contractor or approved organisation they are employed by

Option C MUST Complete Parts 2, 3 & 5.

Option D MUST Complete Parts 4 & 5

Part 2 ASSOCIATE MEMBERSHIP APPLICANT DETAILS (PLEASE PRINT)

(Surname		First Name:
Approved List Employer :(No abbreviations)
Home Address (inc Post Code)
			Post Code:
Home Tel:			Work Tel:
Mobile No:
Email:
(1) Date of Birth			Occupation:
(2) Date of Birth			Occupation:
Type of Card: Pay as you Go Individual Gold Card Family Gold Card Individual Swim Card Family Swim Card Junior Swim Card Type 1 Contractors Fee Type 2 Associate Fee Are you a current HASSRA Leeds Member Y/N Are you a current HASSRA member in another club? →			Joining Date
			Pro Rata Fee Paid	£
			WY Playhouse only 3 mth/6mth/9mth	£
			Please state Region/club
Payment Type	Full or Direct Debit Paid by → (circle payment type)		Total Amount Paid	£
			Cash/Cheque/Credit Card/Direct Debit

Part 3: SPONSOR’S DETAILS (ASSOCIATE MEMBERSHIP) (PLEASE PRINT)

Surname:		First Name:
Home Address
Employer/Dept
Home/Mobile Tel No
Work Tel No	Home/Work email
Relationship to member/associate member (e.g. Child, mother, brother, friend etc)

PART 4 COMMUNITY GROUP MEMBERSHIP - (EXPRESSIONS ONLY)

TITLE	Mr/Mrs Miss etc
Surname		First Name
Home Address (inc Post Code)
		Post Code
Home Tel No.		Mobile No.
Email :
Community Group Name
Community Group Organiser (Name)		Organiser Contact details

Part 5: Terms & Conditions of Membership to HASSRA

APPLICANT STATEMENT – ALL MEMBER TYPES

I agree to abide by the principles of HASSRA Code of Conduct copies of which are available on the HASSRA website http://www.hassra.org.uk/pages/index.asp and the Expression Health & Fitness Centre rules) as published at reception.

I confirm that I am sixteen years of age or over and know of no reason that would prevent me from using the fitness facilities or equipment within Expressions. I know of no medical problems that will put me at risk by using any equipment or exercising and that I have completed a “Par-Q & You” statement prior to using gym equipment.

I accept the Forum Leisure Centre cannot be held responsible for any personal valuables. I also understand that refunds are not given and that if I cancel my membership I must return my membership card to the Forum Leisure Centre and that I must give 4 weeks notice of cancellation.

Please Note: It is the member’s responsibility to cancel their Direct Debit at the bank once the cancellation letter has been received. Parkwood Leisure require 4 weeks notice of cancellation

I agree to the above Terms & Conditions of membership

Signed…………………………………………………… Date………………………………

THIS PERSONAL DATA WILL ONLY BE USED BY HASSRA (LEEDS) AND ITS LEISURE PARTNERS, AND RETAINED FOR THE DURATION OF MEMBERSHIP

TYPE 1 - FULL MEMBERSHIP OF HASSRA Leeds

This allows access to the FORUM and all HASSRA Leeds activities, discounts and offers and is available to anyone working for the Dept of Health (Leeds Central Services) or the Dept for Work and Pensions at Quarry House Leeds. It is also available to: contractors of the above (e.g. G S Hall, Mitie, CSC, Land Securities Trillium etc). Retired DH/DWP staff where a Civil Service Pension is payable.

£18.00 per annum (pa)

PAYABLE BY DEDUCTIONS FROM SALARY FOR FULL-TIME CIVIL SERVANTS, CSC, ATOS, LAND SECURITIES TRILLIUM OR VIA DEDUCTION FROM PENSION FOR RETIRED MEMBERS

TYPE 2 – ASSOCIATE MEMBERSHIP OF HASSRA Leeds

This allows members of certain groups access to all FORUM activities, HASSRA Leeds Events, Trips or to participate/join single activity clubs (e.g. Golf Society). Available to those who work within an organisation on our approved list: e.g. local hospitals, Police, Fire Service, NHS workers, other civil servants and partners, family and friends of qualifying members. Also available to anyone who is already a subscribing member of another HASSRA Regional Association (for example, HASSRA Yorkshire & the Humber). However, it does NOT entitle membership to HASSRA Yorkshire & the Humber, other HASSRA Regions or subsidies on trips/events organised by them.

Adult £30.00 pa Child (prior to age 16)/Members of Other HASSRA Region: £15.00 pa

PAYABLE IN A LUMP SUM AT THE START OF THE MEMBERSHIP YEAR. PAYMENTS SHOULD BE MADE OUT TO “PARKWOOD LEISURE”

TYPE 3 – COMMUNITY USE MEMBERSHIP OF EXPRESSIONS

Members of the local community may apply to use the facilities of Expressions Leisure Centre outside of core use times by HASSRA members, but priority will always be given to HASSRA (Leeds) organised activities. All Community Group applications must be agreed by the Leisure Centre Management Group. This group comprises of representatives of HASSRA and their business partners. Community use will normally be week-days between 09:30-12:00 & 14:00 – 15:30 and all day at week-ends.

Extract from the HASSRA Code of Conduct

HASSRA is a nationwide Recreational Association that was founded in 1935. It provides an opportunity for members to take part in a vast array of sporting, recreational and cultural activities from Angling to Scrabble and Badminton to Photography. As with all activities, events or trips organised by HASSRA, we hope that you enjoy them and find them to be well organised and professionally run - this is our clear aim on every occasion.

Events and activities are an important part of HASSRA's calendar and take a great deal of planning and hard work to organise successfully. They are paid for by members and HASSRA is very mindful that this places an important responsibility on all of us to contribute to the success of each activity/event.

To help you have an enjoyable time and ensure your fellow competitors and colleagues do likewise you are asked to observe the following Code of Conduct, which as an organisation, HASSRA promotes at each of its events.

1. Enjoy your competition - give your all and play to the full. Respect and applaud good play from your opponents as well as your own side and remember - have fun!

2. Be on time, as a basic courtesy, for all aspects of the event. Know the itinerary and how it affects you. No one appreciates a poor timekeeper.

3. Know the rules of the game. Adhere to them in practice and in spirit at all times. If you are unsure, ask for guidance before the event as ignorance or cheating will lose you the respect of those around you, and, more importantly, may cost you success.

4. Never argue with the referee / umpire. It is against the laws and spirit of competition and will gain you nothing and potentially cost you much. Remember that the referee or umpire is likely to be a volunteer and without their help the activity/competition would not take place.

5. Make sure your conduct enhances your reputation or that of those you represent (or have sponsored your membership): Participants should be mindful of their responsibilities as a representative of their Department or Agency, their own HASSRA Association, and also of HASSRA in general - others will be watching, and will form opinions from what they see so be mindful and respectful of others.

6. Drink & Drugs: In particular, participants should have full regard to the Association’s national policy relating to the over consumption of alcohol or the use of illegal drugs or substances. Occasions where the over consumption of alcohol or the use of illegal drugs or substances occur will result in both ejection from an event and notification to the appropriate line managers and the HASSRA Disciplinary Committee.

7. Report Changes to the organisers: Be aware of the proper administration of the activity/event. Report changes in availability and requirements to the organisers timeously and do not bring unauthorised guest to an activity/event.

Above all have an enjoyable time, meet new people, play well and good luck!