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YTFC Disabled Supporters Association - "Help us to help ourselves!"
YTFC Disabled Supporters Association Registration Form

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 : ………………………………………………………………………….
…………………………………………………………………………..
………………………………………………………………………….
………………………………………………………………………….
………………………………………………………………………….
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:
………………………………………………….
IN CASE YOU FORGET THE PASSWORD,WHAT QUESTION COULD WE ASK YOU AS A
PROMPT? ………………………………………………………………………………………………..
……………………………………………………………………………………………………………….
PLEASE ADD ANY OTHER RELEVANT INFORMATION OVERLEAF
A membership card will be issued in due course.


OFFICIAL USE DSA Rec. Mem.




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