Herefordshire Aero Club Ltd
2015 Membership Renewal Form
Please fill in your details below and return this form, either as an email attachment to
accounts@shobdonairfield.co.uk or by post, along with the appropriate renewal fee (or completed Direct
Debit form). Your current membership expires on 31st January 2015. Please call Emma Lloyd if you need
any assistance completing the Direct Debit form.
Membership Details
Name:
Address:
Date of Birth:
Postcode:
Telephone: Home
Work
Mobile
Email address:
Repeat email address:
Occupation:
Emergency contact:
Name
Telephone
Relationship
Membership Renewal
I wish to remain a
Full Flying: £
Senior Flying: £
Student Flying: £
Social: £
Member of the Herefordshire Aero Club Ltd (please fill in the appropriate amount above). I wish to pay by
Direct Debit / cheque / cash / card (please indicate payment method).
Existing Direct debit in place
Pilots’ Details
Licence type, number:
Date of expiry of certificate of experience:
Date of expiry of medical certificate:
Aircraft owned/syndicate member of
Volunteer
Please indicate if you would be able to volunteer for the following - or give the club some particular
professional or practical expertise or enthusiasm – someone will contact you.
Fire Cover
Duty Pilot
Tower Duties
Events
Other (please specify)
Please note that the above details are confidential to the Herefordshire Aero Club Ltd and are held for the sole purpose of
contacting and maintaining a list of members. All the details are held within the regulations set out in the Data Protection
Act and may not be divulged to any other party other than the West Mercia Police to whom all applications are notified
under the Prevention of Terrorism Act 2000.
For office use only
Date Paid
Amount Paid
Epos
Entered on Db
Checked
Herefordshire Aero
Club Ltd
Instruction to your
bank or building society
to pay by Direct Debit
Service User Number
Please fill in the whole form including official use box using a ball point
pen and send it to:
4
4
Herefordshire Aero Club Ltd
0
6
9
1
FOR PSL re Herefordshire Aero Club Ltd OFFICIAL USE ONLY
This is not part of the instruction to your Bank or Building Society.
Shobdon Airfield
Important – Please complete these details:
Shobdon
Account Holder(s) Name & Address:
Leominster
HR6 9NR
Name:
Address:
Name(s) of Account Holder(s)
Postcode:
Email Address:
Bank/Building Society account number
Payment for:
Branch Sort Code
Instruction to your bank or building society
Name and full postal address of your Bank or Building Society
Please pay PSL re Herefordshire Aero Club Ltd Direct Debits from the
account detailed in this Instruction subject to the safeguards assured by
the Direct Debit Guarantee. I understand that this Instruction may
remain with PSL re Herefordshire Aero Club Ltd and, if so, details will be
passed electronically to my bank/building society.
To: The Manager
Bank/Building Society
Address
Signature(s)
DDI1
Postcode
Date
Reference
Banks and Building Societies may not accept Direct Debit Instructions for some types of account
This guarantee should be detached and retained by the Payer.
The
Direct Debit
Guarantee
 This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits.
 If there are any changes to the amount, date or frequency of your Direct Debit PSL re Herefordshire Aero Club Ltd will notify you five (5)
working days in advance of your account being debited or as otherwise agreed. If you request PSL re Herefordshire Aero Club Ltd to
collect a payment, confirmation of the amount and date will be given to you at the time of the request.
 If an error is made in the payment of your Direct Debit, by PSL re Herefordshire Aero Club Ltd or your bank or building Society, you are
entitled to a full and immediate refund of the amount paid from your bank or building society
- If you receive a refund you are not entitled to, you must pay it back when PSL re Herefordshire Aero Club Ltd asks you to
 You can cancel a Direct Debit at any time by simply contacting your bank or building Society. Written confirmation may be required.
Please also notify us.