APSPH Membership Form 2018 - this must be submitted with a copy of the applicants REL certificate

1. APPLICATION FOR MEMBERSHIP
MEMBERSHIP: PLEASE TICK WHERE APPROPRIATE
Annual membership fee: £200.
Payable via BACS:
NATWEST Bank: Sort Code: 56-00-68 Acc No: 37961454
Memberships due on 1st
March annually.
PARTICULARS OF LICENCE (RIDING ESTABLISHMENT ACT 1964/1970)
Name of Licence Holder: Date of issue by authority:
Expiry Date:
Issuing Authority:
PLEASE TICKE TO CONFIRM YOU HAVE ENCLOSED / ATTACHED COPY OF YOUR RIDING ESTABLISHMENT
LICENCE
PARTICULARS OF EMPLOYEE & COMBINED THIRD PARTY LIABILITY OF MINIMUM £5,000,000
Policy Number:
Expiry Date:
Insurance Company:
PLEASE TICK THIS BOX TO CONFIRM YOU HAVE CONTINUOUS THIRD PARTY LIABILITY INSURANCE WITH A
LIMIT OF INDEMNITY OF MINIMUM £5,000,000 AND EMPLOYERS’ LIABILITY INSURANCE
MEMBERSHIP STATEMENT
Name of Establishment:
County:
Address:
Post Code:
Contact Number: Mobile:
Email: Website:
Proprietor: Manager:
MEMBERSHIP APPLICATION
FORM 2018
I hereby agree to abide by the Articles of Association, aims and directives of The Association of Polo Schools and Pony Hirers
and accept that in joining this Association I declare that my establishment is run in accordance with English Law and the Riding
Establishments Act 1964 & 1970. I understand that failure to adhere to the Articles and any aims or directives may result in
the suspension of my membership. I understand that any advice or information I receive from the Association and its Directors
should be checked and verified by myself and any issuing body or organisation concerned.
I understand that my contact and establishment details will only be listed and advertised by the Association on receipt of all
relevant documentation and that my details and membership will be suspended or removed should these documents expire
and are not renewed during my membership oy my membership ceases.
Signed: ………………………………………………………………………….. Date: ………………………………………………………..
Print Name: …………………………………………………………………… Position:……………………………………………………
Return completed form and supporting documents to: APSPH c/o: Ruby Cottage, Alderton, Wiltshire, SN14 6NL
membership@apsph-polo.org.uk
Registered Company Address: CHP, RCBPC, North Street, Winkfield, Windsor, Berkshire, SL4 4TH
Registered Company No: 08822668