(Please circle)
Type of
Membership
Men’s
£70
Ladies
£35
Student
£35
Unwaged
£35
Non-Playing
£15
Contact Details
…………………………………………………...............
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…………………………………………………...............
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Postcode:
…………………………………………………...............
Date of Birth: …………………………………………………...............
Home Tel:
…………………………………………………...............
Mobile:
…………………………………………………...............
Name:
Address:
CLUB COMMUNICATIONS ARE BY EMAIL – PLEASE PROVIDE AN EMAIL ADDRESS BELOW
Parent’s Email …………………………………………………...............
(If you would like your parent copied into club correspondence – ** recommended for under-18s**)
The club would like to be able to pass on your telephone number to other team members (if required)
so that transport and travel to matches and events can be easily arranged and shared between
players. This is not to produce a list for general distribution. Please read, sign and date the
statement below with your wishes regarding the use of your contact details. Please note that your
email address may be visible to others in miscellaneous club correspondence.
I give / do not give (please delete as appropriate) my permission for my telephone number(s) to be
issued to other members of Kinross-shire Cricket Club if required. I understand that they will not be
forwarded to non-members or other organisations without my permission.
Signed: ………………………………
Date: ………………………..
Parent to sign if under 16 years
Signed: ……………………………… (Parent)
Date: ………………………..
Additional Information
Next of kin/contact in the event of injury ……………………………………………
Tel: ………………………...........................................
Do you have any medical conditions, allergies or particular issues that the Club should be
aware of in case of injury or illness whilst playing for the Club? (if yes please give details)
……………………………………………………………………………………
……………………………………………………………………………………
Do you consent to the use of photographs, film or video recordings for training and
marketing purposes (e.g. club website etc.)?
Y / N
Are you willing to assist the club in any of the following areas?
Fundraising
Umpiring / Scoring / Both (delete as appropriate)
Groundsmanship
Coaching
Occasional Help (e.g. the Fun Run stewarding, painting the pavilion)
Y
Y
Y
Y
Y
/
/
/
/
/
N
N
N
N
N
Kirsteen Ross, Club Secretary, 15 Springfield Park, Kinross, KY13 8QS 07740 676104 email: [email protected]