Pfascotland - Membership Form

Full Name:*

Date of Birth:*

Address:*

Town/City:*

Postcode:*

Mobile

Email*

Nationality:*

Current Club:*

Position

MEMBERSHIP LEVEL (select option below, IF UNKNOWN LEAVE BLANK)

Level 1Level 2Level 4Amateur

Membership rates are as follows

Level 1 - £13 per month (full time players earning over £400 per week)

Level 2 - £6.50 per month (part time players and full time players earning less than £400 per week)

Level 4 - £0.88 per month (apprentice players who are 20 years of age or under)

Amateur - £0.88 per month (any player who is playing in the SPFL or SWPL who has not signed a professional contract)

You can also pay your membership annually by selecting the Annual payment option

NoYes

DIRECT DEBIT INSTRUCTIONS

Name of Bank/Building Society:*

Account Holder Name:*

Account Number:*

Sort Code (numbers only):*

Originator’s identification number: 388364

Instructions to your Bank or Building Society. Please pay PFA Scotland Direct Debits from the account detailed in this instruction subject to the safeguards assured by the Direct Debit Guarantee. I understand that this instruction may remain with PFA Scotland, and if so, details will be passed electronically to my Bank/Building Society.

PRIVACY STATEMENT

HOW INFORMATION ABOUT YOU WILL BE USED

For further information on what we do with your data please see our privacy statement

CONTACTING YOU

PFA Scotland will keep you up to date with relevant Trade Union business as well as offers from our Business Partners.

Do you wish to receive this information by SMS or email?*

YesNo

Any other information you may wish to add: