Rec’d
by
Club fee
Cheque
Cash
Mem Card
Issued

Ellenborough Table Tennis Club

Craddock Road, Enfield, EN1 3SP. Tel 020 8363 1585

(Community Amateur Sports Club No. 05153)

Membership Application Form

Season 2016-2017

Please complete in clear handwriting and together with appropriate membership fee return to

Ron Smith, 16 Waverley Road, Enfield, Middlesex, EN2 7BT Tel 020 8363 8643 Alternatively leave on the post board or box on the bar in the Club.(Please make Cheques payable to Ellenborough Table Tennis Club)

Annual membership runs from 1st September-31st August. New members joining part way through the season will be charged on a pro rata basis.

Annual Membership Fees
Type of membership / Adult / Junior (born in 1998 or later)
Basic (non league player) / £130.00 / £65.00
Full (league player) / £155.00 / £77.00
Family* / Club fees are discounted at 25% for family membership
Social / £5.00 / £5.00

From 1st January2017 there will be an additional playing fee of £1.00 payable on entry to Club at time of visit

*Defined as at least 1 adult member (other than social member) and one junior or adult in full time education

Note: Adult in full time education under 30 on 1st Sept 2016 qualifies for junior rates

Please indicate type of membership applying for / Type: / Fee £

Personal Details

Surname / Title
First name
Address
Post Code
Date of Birth
Gender / Male  Female 
Contact Details / Home / Mobile
email
TTE individual Registration No.
Nationality

I have read and agree to abide by the Club’s rules and codes of conduct. I agree to the information on this form being stored on computer under the provisions of the data protection act.

Signed / Date

For those under 18 this form should be signed by a parent/guardian

I understand that my son/daughter/child in my care is required to abide by the Club’s rules and codes of conduct, and that in the event of an accident all reasonable steps will be taken to use the emergency contacts.

I give/do not give* permission for the administration of appropriate urgent medical treatment including anaesthetic. (*delete as appropriate)

I give/do not give* permission for my son/daughter/child in my care to appear in photographs, taken during club activities, used in club publicity material, press releases & on the club web site. (*delete as appropriate)

Signed / Parent/Guardian
(delete as appropriate) / Date

PTO

Medical Information

Please detail below any medical information that the Club should be aware of relevant to your participation in club activities. This information will be treated confidentially and on a ‘need to know’ basis.
Medical condition
Emergency contact name(s) and number(s)
Name of doctor and contact number

Coaching

Do you hold any coaching qualifications. If so please state what level

TTE Individual Membership

The club will no longer be taking payment responsibility for Table Tennis England membership. You should now apply direct to TTE to renew your membership. The following rates apply.

Player Membership

For all those who wish to play in local leagues or 1* national tournaments

Senior £12.00

Junior £ 6.00

Player Licence

For all those who play in British League or 2* or above national tournaments

Senior £34.00

Junior £17.00

Associate Membership

For club players who do not take part in any form of competition but wish to be affiliated with TTE

Free