Little Chalfont Tennis Club (LCTC)

Application Form 2014/15

Valid to 28 February 2015

Category / Description / Year / 25% off
Adult / (A) / any adult aged 23 years or over / £150 / £112
Couple / (C) / two adults at the same address / £270 / £202
Family / (F) / two adults, under 23s (born after 1.9.90) same address / £335 / £251
Student / (St) / Born after 1 Sept 1990 and absent during term time / £30 / £22
Young / (Y) / Born after 1 Sept 1990 and on or before 31.8.1997 / £65* / £49*
Junior / (J) / Years 3-11 at 1 March 2014 (DOB 1.9.97 - 31.8.06) / £65* / £49*
Mini / (M) / Year 2 and younger: born after 1 September 2006 / £20* / £15*
Social / (Soc) / non-playing adult / £15 / £11

*A discount of £5 is given for Young, Junior and Mini members if either parent is a member.

Name of Member / Male / Female
Membership Category and Subscription:
Address
Postcode
Email
Please type or write very clearly.
Date of birth (if 23 or under)
Phone (landline)
Phone (mobile)
A clubhouse key may be requested by members aged over 18 only. It gives access to the clubhouse and enables you to turn the floodlights on and off to play up to 9pm on dark evenings. There is a charge of £10. Please indicate if you would like one: Yes / No

c  Tick here if you don’t want your details to be given to the Head Coach.

c  We’ll circulate emails and phone numbers of adults who’d like to be included to other members aged over 18. Tick here if you don’t want your contact details circulated.

Anything else we should know? (eg medical conditions for under 18s)

………………………………………………………………………………………….…………

I enclose a cheque / have made a transfer to Little Chalfont Tennis Club for £ …………..

Please post the completed form with your cheque to our Membership Secretary:

Gill Kirkpatrick, 60 Lincoln Park, Amersham, Bucks HP7 9HD or if you’d like to pay electronically email the form to and give your name as a reference when originating the bank transfer. Our bank details are:

Little Chalfont Tennis Club, HSBC Amersham, Sort code40-08-41, Account91130315.

Please complete the relevant parts of the form for each member: identical information, such as address, need not be repeated. Payment can be made for several members with the same cheque or transfer.