Transport Salaried Staffs' Association

Step 1. Personal information

• Title * Mr Mrs Miss Ms Doctor Lord Earl Captain Rev Major
• Forenames *
• Surname *
• Gender * Male Female
• National Insurance Number
• Home Postcode *
• Select Address
• Address 1 *
• Address 2
• Address 3
• Town *
• County
• Main Contact Number
• Email Address *
• Date of Birth * DD 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 MM 01 02 03 04 05 06 07 08 09 10 11 12 YYYY 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900
• Have you been a member of TSSA before? Yes No

• TSSA is committed to promoting equal opportunities. To make sure our service meets your needs it is essential to monitor recruitment. Information you give us in this section will remain strictly confidential and is not a requirement of membership.

• Do you consider yourself to be a person with a disability? Yes No I'd rather not say
• Which of these ethnic groups best describes you? ASIAN BANGLADESHI ASIAN INDIAN ASIAN OTHER BACKGROUND ASIAN PAKISTANI BLACK AFRICAN BLACK CARIBBEAN BLACK OTHER BACKGROUND CHINESE MIXED OTHER BACKGROUND MIXED WHITE ASIAN MIXED WHITE BLACK AFRICAN MIXED WHITE BLACK CARIBBEAN OTHER ETHNIC GROUP WHITE BRITISH WHITE IRISH WHITE OTHER

Step 2. Job Details

• Employer *
• Department
• Job Title *
• Job Grade
• Your Workplace Postcode *
• Select Address
• Address 1 *
• Address 2
• Address 3
• Town *
• Do you work more than 26 hours per week? * Yes No
• Date joined current employer * DD 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 MM 01 02 03 04 05 06 07 08 09 10 11 12 YYYY 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900
• Are you a Modern Apprentice? Yes No

Step 3. Choose your membership preferences

• I wish to pay * Select one Four-weekly (13 payments per year) Monthly (12 payments per year) Quarterly Twice a year Annually

  Pay Frequency	Fulltime Rate	Parttime Rate
  Four-weekly (13 payments per year)	£ 14.80 will be debited from your account	£ 7.40 will be debited from your account
  Monthly (12 payments per year)	£ 16.08 will be debited from your account	£ 8.04 will be debited from your account
  Quarterly	£ 48.24 will be debited from your account	£ 24.12 will be debited from your account
  Twice a year	£ 96.48 will be debited from your account	£ 48.24 will be debited from your account
  Annually	£ 192.96 will be debited from your account	£ 96.48 will be debited from your account

  We offer reduced rates for modern apprentices please phone the membership team for more information

• Data Protection

•  
  By accepting this form I acknowledge that the personal data provided by me in this application form (updated from time to time as appropriate) will be used in accordance with the data protection notice available on request and published regularly by the Association.

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  I am prepared to receive third party mailings from TSSA accredited suppliers. Deselect if you disagree with this statement

Step 4. Direct Debit Details

• Your Bank Name *
• Branch Sort Code *
• Bank/Building Society account number *
• Name(s) of Account holders *
•  

  Please confirm these details are correct then validate

   
  
  Validating the bank account...please wait...
• Date to be debited Four-weekly (13 payments per year) Monthly (12 payments per year) Quarterly Twice a year Annually
• Amount to be debited £ 14.80 £ 7.40 £ 16.08 £ 8.04 £ 48.24 £ 24.12 £ 96.48 £ 48.24 £ 192.96 £ 96.48
• Instruction to your Bank or Building Society

  Please pay TSSA direct debits from the account detailed on this instruction subject to the safeguards assured by the Direct Debit Guarantee.

•  

  The Organisation name which will appear on your bank statement against the Direct Debit will be TSSA. All communications associated with the Direct Debit will be sent to your membership address.

  I understand that this instruction may remain with TSSA and, if so, details will be passed electronically to my Bank/Building Society.

• Choose how to submit
  Submit application online if:
  These are your account details and you confirm you are the only required authorised signatory. A letter confirming your direct debit details will be sent to you within 3 working days.

•  
  Submit application by post if:
  i) You prefer not to submit details online or
  ii) The account needs more than one signature or
  iii) You are not the main account holder

•  

   

  I apply to join the Transport Salaried Staffs' Association for the purposes of collective bargaining at the appropriate subscription and will observe the rules of the Association.

Please choose a submission option above and ensure bank account details are validated above.

After you submit the form you will have the opportunity to print your submission.