new ...juniors.latika.co.uk/wp...membership-form-2015.pdf · parent/guardianname(s):...
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www.latika.co.uk
Parent/Guardian Name(s):
Telephone Number Home:
Address: Telephone Number Mobile:
Email Address:
Postcode: Farley Wood Member YES □ NO □Coaching Group (For New Members) Court Key £10 Deposit YES □ NO □
YES □ NO □
CHILDREN'S DETAILS DOB Male/Female British Tennis Membership Number:
Name
Name
Name
Name
Medical conditions:
RENEWAL COSTS 1st JULY 2015 (New Membership please refer to Subscription Rates Schedule in the Clubhouse)
1st Child -‐ £39.00 2nd Child -‐ £32.50 3rd Child -‐ £26.00 4th Child -‐ £19.50
Payment Method: (two ways to pay: Internet Banking or Cheque -‐ see section 1 and 2 below)I/we enclose a cheque payable to Latika Junior Tennis Club / have paid direct to club's Bank Account 91027735 Sort Code 40-‐13-‐10
for the amount: £
1. Internet Banking -‐ USED FOR RENEWALS ONLY
To confirm Internet Banking please send confirmation of the amount and reference to : [email protected]
Bank transfer date
Reference to use during transfer: BTM number / surname
2. Cheques: (post or leave in Clubhouse)
Payable to: Latika Junior Tennis Club. New Membership cheques are processed via the Saturday Desk.
Renewal Membership, cheques can either be left at the Clubhouse with completed Form in an envelope addressed to Adele Youngl,
or Post cheque and Renewal Form to: Memberships, Adele Young, 20 Oakdale, Bracknell, Berkshire, RG12 0TG
Signature : Date:
By renewing/applying for the above membership you are also agreeing that the member(s) will be bound by and subject to the LTA Rules and the LTA Disciplinary Code,details of which can be found at www.lta.org.uk. By renewing this membership, you are agreeing that the club may store and use the information supplied,for internal purposes and to communicate with you.
Official Use only Committee Member Signature Date Fee Paid Receipt Issued?
NEW/RENEWAL MEMBERSHIP APPLICATION -‐ 1ST JULY 2015 TO 30TH JUNE 2016
Please tick the box if you are happy for your Child(ren) to be photographed or videoed during coaching for the purpose of assessing their progress or for club publicity.
(for each additional child £6.50 has been deducted)
Membership Type: New / Renewal