2017 APPLICATION FORM NEW / RENEWAL / PLAYING MEMBERSHIP

Membership Period: 1 January to 31 December 2017 inclusive

Adult Playing Membership Fees £105 Unemployed/Mature Students £65

Joining Fee (New Members only): £15

Please note fees include: Winter Indoor Nets and Outdoor coaching & trainin

Total Payment made £______By Cash / Cheque / Debit Card (Cheque no ______)

1. Your completed application together with the total fees payable must be posted to or, preferably, delivered by you personally at:

Luton Town & Indians Cricket Club,

The Clubhouse, Wardown Park, Old Bedford Road, Luton, LU2 7HP

Note: The Clubhouse is open daily on Weekdays from 16.00 and Weekends from 12.00.

2. Terms and Conditions of Membership:

i.  Medical Information: It is important that, as a Playing Member you inform the club of any medical information of which our coaches should be aware (e.g. epilepsy, asthma, diabetes etc.). Such information will be not be disclosed by the club to a third party without your express authority and will be retained by the club in strict confidence

ii.  Consent for Photography and Images: occasionally, photographs and/or video footage will be taken by the club and may be used for promoting our club on the LTICC Website or news media. Before taking any pictures of you we need your permission to do so. Therefore, please signify your consent or refusal by circling: Yes or No.

3. Declaration:

I understand and accept that:

i.  The membership application process may take up to 4 weeks to complete.

ii.  That the above information provided by me is correct at the date of application.

iii.  Subject to the approval of my membership application, the benefits of membership will apply to me only and cannot be transferred to a third party;

Further, as a Member Of Luton Town & Indians Cricket Club I Agree To:

iv.  Abide by the Club Rules and Constitution and all Bye-Laws laid down by the Club.

v.  Ensure that each guest whom I introduce to the Club is signed-in by me on each occasion of their visit and are accompanied by me throughout their visit.

vi.  Be responsible for the conduct and behaviour of my guests at all times whilst they are on the club premises and to be accountable to the members of the club for any loss or damage the club may suffer as a direct consequence of the behaviour or conduct of my guest(s).

vii.  I confirm that I have read and understood the “Adult Players’ Guidelines”

SIGNATURE: DATE: