BGA Membership Application Form

Name^* _________________________________________

Telephone _________________________________________

Address _________________________________________

_________________________________________

Post code _________________________________________

Email _________________________________________

Grade (if known) ________ kyu / dan

Club (if any) _________________________________________

I heard of the BGA from _________________________________________

I wish to join the BGA for _____ years at £________ per year.
(Concessions please specify: ❏under-18 ❏student ❏unemployed ❏pensioner.)

❏ I enclose a donation of^† £________ for outreach purposes.
❏ Other go players may be given my name to help the formation of new clubs.

I would like to receive the newsletter ❏by email ❏in the post.

I agree that the BGA may keep a record of this information, on the understanding
that it will not be passed on to any other organisation, except as required by law.

Signed _________________________________ Date __________________

^* Under-18s, please give your date of birth too. Families, please give the details of all
family members. Use the back of the form if necessary.

^† £10 suggested. Any donation will be used to help promote Go.

Last updated 1st April 2007.

Promoting Go in the UK and beyond