Hazlemere Community Association

Member Application Form 2025

I wish to make an application for Hazlemere Community Association Membership and am aware of the terms of the Constitution and Conditions of Membership.

Legal Note: To Comply with the licensing laws it is a requirement that you have your membership card with you whenever you use the club facilities. You will be refused entry to the bar area if no proof of membership is offered.

All applications are submitted for approval to the HCA Social Club and Management Committees. You can apply by:

Completing and sending the on-line form below. You will be contacted by the HCA Secretary.
You can print the form and then return the completed form, with your remittance, to one of the following:
- the HCA Secretary
- to the Bar Staff
- to the person carrying out the Membership Check at the door.
Your Membership Card should then be available for collection at the end of the current month.

Your title (Mr, Mrs, Ms etc.)*:

* shows a required entry

Your first name *:

Your Second Name *:

Your address *:

and Postcode *:

Do you live in one of the Following Parishes? Chepping Wycombe, Hazlemere, Little Missenden, Penn? * (If not, you will only be entitled to Associate Membership) Yes No Telphone Number *: Email address : Do you wish to receive newsletters and information about forthcoming events using this email address? (you can always unsubscribe later) Yes No

Date of Birth (dd-mm-yyyy)*: (proof of age may be required)

Office use only:

Membership No. issued ▢
Proposer Checks 1) ▢ 2) ▢
Full ▢ Associate ▢

Membership Card prepared ▢
File Card Prepared ▢
Computer Files updated ▢

Remttance due *: + £15.50 - Annual Subscription
+ £14.50 - Over 60 Annual Subscription
+ £62.00 - Five year Subscription
+ £58.00 - Over 60 Five year Subscription
£75.00 - Life membership Subscription
+ includes initial joining fee of £1.50
All subscriptions (other than LIFE) are renewable on 1^st October

Payable by *: Cash Cheque Paypal (see About for Paypal button)

Gift Aid - I would like the Hazlemere Community Association to reclaim tax on any subscription that I make after 6th April 2025 and I declare that I have paid an amount of income tax or capital gains tax equal to any tax deducted. *: Yes No

We would appreciate knowing the reason you are applying for Membership, e.g. joining a Section or an Affiliated Organisation, making use of the bar facilities etc. If you are joining a Section etc, please state which:

Would you like to help as a volunteer to run the bar at the Community Centre? *: Yes No

Membership of the Community Association entitles a person to join the Hazlemere Community Association Social Club Ltd. The rules of the club provide that each applicant must be proposed and seconded by current Club Members. Membership also entitles each person to apply to join any of the Sections of the Association.

Proposer *:

Membership No. *:

Seconder *:

Membership No. *:

By using the check or send button below, I agree that:

By signing below, I agree that:

I will abide by the rules of the social club and confirm that I am over the age of 18.
I agree that the Association may keep computer records, information and data as provided on this form. The Association will not disclose this information to any third party or organisation except for administrative purposes.

Your Signature:

Dated:
11th June 2025

Registered Charity in England: 258071

Hazlemere Community Centre
Rose Avenue
High Wycombe
Buckinghamshire
HP15 7UB