Aberystwyth Lawn Tennis Club Membership 2015-2016 Please complete in BLOCK CAPITALS. Membership runs from Title: Miss Mrs Ms Master Mr Other: First Name: Associate Parent Name: st st April 1 2015 – 31 March 2016 Date of Birth & School Year: DD/MM/YYYY Surname: (Primary school age membership only) Address: Town: Post Code: Telephone: Mobile: Email: Does the applicant have any medical conditions that the club should be aware of? Please give details below: Membership Categories ü Family members: please complete a separate form for each playing member of your family Senior Individual Membership £90.00 Secondary School Age Membership Primary School Age Membership £35.00 *Please complete consent section below £20.00 (includes associate parent/guardian) Student Membership – Open to those in full -time University education £35.00 Family Membership– includes 2 adults and their children. Lead Member £140.00 Family Membership Partner/Junior. £0.00 Please supply lead members name below Country Membership – living more than 30 miles away £50.00 Country Family Membership – living more than 30 miles away £80.00 Concessionary Membership - £20.00 Available to job -seekers and those claiming benefit Lead Member: I/W e confirm that I/W e wish to join Aberystwyth LTC and agree to abide by the rules of the club Signature__________________________________________________ Signature of parent or guardian (if under 18) Date: ___________________ ____________________ __ Date: ___________________ *Consent for Secondary School Members By signing below I give permission for ________________________ to play tennis at Aberystwyth Lawn Tennis Club unsupervised. Signature of parent or guardian___________________________________ Date: ___________________ Payment: I enclose a cheque for £ payable to ‘Aberystwyth Lawn Tennis Club’ Please send completed application & payment to: June Blake, Membership Secretary, Ty Capel, Tynygraig, Ystrad Meurig. SY25 6AE W elcome to Aberystwyth Lawn Tennis Club 1