PSSA - Prison Service Sports Association

   Please print and fill in the forms below.

  World Police and Fire Games
   Barcelona 2003 JULY 27 - AUGUST 03

PSSA/H3

Application to attend the above WPFG is attached for you to complete along with a Medical Disclosure Form to be returned to PSSA HQ. Please ensure you complete all questions fully and print information clearly.

The subsidy allowance for each member of our Association, who is to compete at the Games, shall be up to a maximum of £300 and is to be offset against accommodation costs.

A Non Refundable deposit of £50 per person is to be paid on application (if your spouse is to accompany you then the deposit will be £100).

To finalise registration a £30 per month direct debit is attached for you to complete. It would be helpful if you deposit this standing order with your respective bankers and send a photocopy to me for file.

Preliminary visits to Barcelona are to be undertaken by members of the Executive to explore suitable accommodation, transport arrangements, venues for sporting activities and other amenities to ensure a successful and enjoyable Games.

Should you have any queries please do not hesitate to contact me.

Regards,

Tracie Jones
PSSA Co-ordinator

World Police and Fire Games
Barcelona 2003 JULY 27 - AUGUST 03

PSSA/H3A

Application form to be completed in FULL and returned together with deposit(s) and completed New Standing Order Authority.

Full Name and Address

Mr - Mrs - Miss - Ms

____________________________________________

Postcode

Home Telephone

Work Telephone

Establishment

____________________________________________

______________________________EXT___________

Full Name of Spouse/Partner (if attending the games)

Mr - Mrs - Miss - Ms

____________________________________________

Chest Size

Waist Size

Inside Leg

Shoe Size

_______________________

Sport(s) you wish to compete in

____________________________________________

Civil Service Sports Council Membership Number

_____________________________

World Police and Fire Games
Barcelona 2003 JULY 27 - AUGUST 03

PSSA/H3B

Application form to be completed in FULL and returned together with deposit(s) and completed New Standing Order Authority.

FULL NAME

____________________________________________

DATE OF BIRTH

PARTNER IF ATTENDING

FULL NAME

DATE OF BIRTH

____________________________________________

CHILDREN ATTENDING

FULL NAME(S)

DATE(S) OF BIRTH

____________________________________________

MEDICAL DISCLOSURE (If not applicable write NONE)

Signed____________________________________________

Dated__________________

*PLEASE PRINT CLEARLY USING CAPITAL LETTERS*

To:

Bank:

Address:

Sort Code:

____________________________________________________________

Dear Sir / Madam

Please accept this as my instruction to set up the following standing order on my account: -

Account Name to be debited:

____________________________________________

Account No. to be debited:

Recipient's Name:

Recipient's Bank & Branch:

Prison Service Sports Association (Barcelona 2003)

Lloyds TSB Bank Plc
14 Church Street
Rugby
Warwickshire
CV21 3PL

Recipient's Sort Code:

Recipient's Account No:

Amount & Frequency of payment

First Payment Date:

Last Payment Date:

30-97-17

01007711

£30.00 monthly

____________________________________________

Signed____________________________________________

Dated__________________