APPLICATION FOR LICENCE

FULL NAME

____________________________________________

ADDRESS

                   ____________________________________________                

                   ____________________________________________  

POST CODE  ______ ______           TELEPHONE NUMBER    _______________

e-mail address

_________________________________________

Name of Club – if applicable    

__________________________________________ 

         

Date of Birth       _____________       Nationality ______________

Current licence number if renewing: JSY_ _ _ _

(Licences are valid from 1 January to 31 December annually)

Signature: _____________________  Date: ___________

Please send completed form, a cheque payable to JPA for the annual fee of £12 AND one passport photograph to the secretary:

Mrs. E Paisnel, Wychwood, La Grande Route des Sablons, Grouville, JE3 9FD.