To apply for membership of the Yeovil Town FC Disabled Supporters Association please print off the membership application form below and send to: DSA Membership Secretary, 57 Ashmead, Yeovil, BA20 2SQ. Tel: 07790 375250.

YTFC DISABLED SUPPORTERS ASSOCIATION

PLEASE PRINT CLEARLY. ITEMS MARKED # ARE OPTIONAL BUT
WOULD BE USEFUL TO THE DSA. MEMBERSHIP IS FREE BUT WE ARE
ALWAYS HAPPY TO RECEIVE DONATIONS TO HELP OFFSET COSTS.
FULL NAME:
MR/MRS/MS …………………………………………………………………….
AGE IF UNDER 18: …………
HOME ADDRESS : ………………………………………………………………………….
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TELEPHONE NUMBER: ……………………………………….EX-DIRECTORY?
(IF EX-DIRECTORY ACCESS TO YOUR NUMBER WILL BE RESTRICTED)
#MOBILE NUMBER: ……………………………………………….
#EMAIL ADDRESS: ………………………………………………….
DO YOU WISH TO REGISTER AS:
A DISABLED MEMBER OR 2) AN ASSOCIATE MEMBER
(eg HELPER, ASSISTANT) IF DISABLED PLEASE INDICATE TYPE:
. WHEELCHAIR AMBULANT BLIND DEAF

IF YOU HAVE A BLUE BADGE: PLEASE ENTER THE ISSUING LOCAL
AUTHORITY, THE SERIAL NUMBER AND THE RENEWAL DATE:
………………………………………………………………………………………………
IF NOT: PLEASE ATTACH A COPY OF ENTITLEMENT TO BENEFIT,
OR A LETTER FROM YOUR DOCTOR.

DO YOU INTEND TO BUY A SEASON TICKET? YES NO
IF YES, WHICH STAND? BARTLETT MAIN WESTLAND
(THIS INFORMATION CAN HELP WITH STEWARDING /SAFETY ISSUES)

IF YOU ARE A DISABLED MEMBER PLEASE PROVIDE A PASSWORD
WHICH IS EASY FOR YOU TO REMEMBER:
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IN CASE YOU FORGET THE PASSWORD,WHAT QUESTION COULD WE ASK YOU AS A
PROMPT? ………………………………………………………………………………………………..
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PLEASE ADD ANY OTHER RELEVANT INFORMATION OVERLEAF
A membership card will be issued in due course.

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