Ucc Graduate Membership Application Form

UCC GRADUATE MEMBERSHIP APPLICATION FORM

Name: ______M / F Name: ______M / F (Couple membership)

Name: ______Date of Birth: ______

(Child)

Name: ______Date of Birth: ______

(Child)

Tel No: ______Mobile No.: ______

Home Address:______

______

Email Address: ______

UCC Graduation details

UCC Name (if different): ______Year of Graduation ______

Student No.: ______(Produce Student ID for recent Graduates)

DegreeDetails: ______

______

MEMBERSHIP TYPE

Single Couple

Full Membership Category 1

Pool Only

Category 2

Gym Only

MEMBERSHIP PAYMENT OPTIONS

(Please Tick Appropriate Box)

Paying in Full

Membership Amount: ______

Cash Cheque Credit Card Joining Fee: ______

Children: ______

Total Amount Paid: ______

______

Paying by Direct Debit

First payment in First Months Fee: ______

Cash Cheque Credit Card Joining Fee: ______

Children: ______

Total Amount Paid: ______

I have read, understood & agree to comply with the membership terms & Conditions

Signed: ______Date______

Receptionist Initials______Date______