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Bournville Radio Sailing and Model Boat Club

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BRSMBC Membership form

Membership Year*

New Member / Renewal*

First name*

Surname*

Street*

Address line 2 if required

Post Town*

Post Code*

Email*

Mobile Phone*

home Phone

Date of birth Required for MPBA

Day

Month

Year

Membership required*

MYA Membership*

MPBA Membership*

MYA Number If Known

MPBA Number If Known

Emergency contact details

Emergency contact name

Emergency contact Phone

Emergency contact address*

I agree with my details being shared with the MYA and or MPBA*

BRSMBC 2025

Valley Parkway, Bournville Lane, Birmingham, B30 1QS

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