Henley & Shiplake Waters
MEMBERSHIP APPLICATION FORM
SEASON 2025/2026
FIRST NAME  ………………………………………………………………………      
SURNAME    ……………………………………………………………………..
ADDRESS       …………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………
COUNTY………………………………………………POST CODE …………………………………………
TELEPHONE NO………………………………… MOBILE………………………………………………..
E-MAIL ADDRESS .................................................................................................
VALID (CURRENT) ROD LICENSE NO 
    ………………………………………………………………………. (MANDATORY).

(INSERT YOUR EA PURCHASE REF NUMBER IF LICENSE NOT YET RECEIVED)

AGE AS AT 1ST APRIL 2024…………………………………………………………………………………

PLEASE TICK.
FULL/SENIOR REMENHAM PERMIT                                                                 £35.00		
CONCESSIONARY (OVER 65 OR REGISTERED DISABLED)                                £25.00		
JUNIOR (UNDER 16 AS AT 1STAPRIL 2024)                                                      £20.00		

CHEQUES MADE PAYABLE TO: REMENHAM ANGLING SOCIETY

DECLARATION. I, the undersigned, hereby agree to adhere to the constitution and all the rules of the Society

SIGNED…….………………………………DATE ……………………………………………

If under 16 years old – Parent/Guardian to sign above and denote name here

………………………………………………………………………………………

APPLICATIONS BY POST TO:
Andrew Crook
13 Simmons Road Henley on Thames Oxon RG9 2ER