Authority for Deduction from Pay - Sports and Social Clubs

North East Zone

Please return to;-BTLRC, P.O. Box 22, LEEDS, LS16 7UH

PART 1 - Application to Sports and Social Club

I, (Full Name) ....................................................

wish to become a subscriber to LEEDS Recreational Club (BTLRC)

I am willing to contribute £................p per month

(Insert 44p for membership plus 44p for each lottery ticket)

Employee Identification No (EIN): ......................................

Signature: ................................... Telephone No: .......................................

Grade: ............................. Date: ....................................

E-mail..................................................................................

Home Address: ................................................................................................

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Authority for Deduction from Pay - Sports and Social Clubs

North East Zone (Fund NESSC 2271)

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PART 2 - Pay Group Authority

I (Full Name) ....................................................

wish to become a subscriber to LEEDS Recreational Club (BTLRC)

I am willing to contribute £................p per month

This form supercedes any previous authority for this club.

Employee Identification No (EIN): ......................................

Signature: ................................... Telephone No: .......................................

Grade: ............................ Date: ....................................