BLYTH TENNIS CLUB

MEMBERSHIP FORM 2014/2015

PARTICIPANT DETAILS (families can use same form if more than one junior member )
Name 1: Date of Birth: ____/____/____ mobile:
Name 2: Date of Birth: ____/____/____ mobile:
Name 3: Date of Birth: ____/____/____ mobile:
Name 4: Date of Birth: ____/____/____ mobile:
Name 5: Date of Birth: ____/____/____ mobile:
Postal Address:
Street Address:
Home Phone Number: Email:
EMERGENCY CONTACT:
Name: Email:
Phone Number: Mobile Number:
MEMBERSHIP SUBS: (DUE 5th GAME – 23rd NOVEMBER)
Forms Team Captain/Manager or Secretary prior to the first game. Subs will receive a discount if paid to Treasurer by 5th game.
·  Seniors $100.00 ($90.00 if paid by 5th game)
·  High School $60.00 ($55.00 if paid by 5th game)
·  Primary School $50.00 ($45.00 if paid by 5th game)
·  Sub Junior (practice only) $15.00
·  Social $15.00
Payment of subs: (please tick payment method)
o  Cheques written to Blyth Tennis Club & given to Treasurer or your Team Captain/Manager;
o  Cash placed in a names sealed envelope & given to Treasurer or your Team Captain/Manager;
o  Electronic funds transfer to: BSB 105 030 Account Number 037059740. Please type your name in reference and also send an email confirming transfer to Carol at .
PLEASE TICK THE BOXES BELOW TO SHOW YOU HAVE READ THE FOLLOWING:
o  I understand that all subs are to be paid to the Treasurer by the 5th game and after this selection priority will be given to financial members.
o  I have read and understand the Blyth Tennis Clubs Code of Conduct.
o  I have read and understand the relevant Selection Policy and Challenge System.
o  I provide consent for the BTC to record my/my child’s image (photograph or video footage) for promotional purposes. I understand images may be used in mediums including: publications and promotion material, and broadcast, print and electronic media.
o  I am aware that players/parents are encouraged to first approach their Captain or Team Manager if issues arise, and then the President if issue continues.
Have you played at another tennis club before? Yes/No
Do you have a 15 digit Mytennis ID number? ______
Please tick appropriate boxes below.
o  Opt in to receive communication from Tennis Australia
o  Opt in to receive communication from Tennis South Australia
Form must be signed by a parent/guardian or caregiver for players under the age of 18.
Signature: Date: _____/_____/_____
Name: Relationship:

President: Wayne Carling Ph: 0428 813 861 email:

Secretary: Simone Bigg Ph: 0412 755 748 email:

Treasurer: Carol Virgin Ph: 0417 845 760 email: