NEW ...juniors.latika.co.uk/wp...Membership-Form-2015.pdf · Parent/GuardianName(s):...

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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  : membership@latika.co.uk

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

membership@latika.co.uk