Stourport cricket club Senior section
Player/Member Registration Form
Season 2017
Players Full Name …………………………………………………………………..
Players Full Address…………………………………………………………………………………………………………
……………………………………………………………………… Postcode……………………………………………
Contact Numbers: Home……………………………………………Mobile…………………………………………………
E MAIL Address……………………………………………………………
Date of Birth ………………………………Age…………………..
TYPES OF MEMBERSHIP-Please tick one and forward this form and necessary payment to ;-
Please post to Lynn Cook.17 Pembroke Way.Stourport on Severn.Worcestershire.DY13 8RY
To be received no later than 1st April 2017 OR HIGHER FEES APPLY
1. 1.FULL ADULT (over 18) £70 PER YEAR SHIRT SIZE REQUIRED
Includes playing shirt every 2 years £90 IF PAID AFTER APRIL 1st Please circle
2.FULL TIME STUDENT(over 18) £35 PER YEAR 2XS, XS, S, M, L, XL, 2XL, 3XL, 4XL
Includes playing shirt every 2 years £45 IF PAID AFTER APRIL1st
If you would like to add a kit bundle
3. NON PLAYING MEMBER(ASSOCIATE) £5 PER YEAR(1ST MEMBER OF of playing trousers and a training
FAMILY) £1 THEREAFTER shirt for £25 please tick
4. LIFE MEMBER £FOC (£20 for a shirt if req) (THIS YEAR ONLY)
TROUSER SIZE REQUIRED
2XS, XS, S, M, L, XL, 2XL, 3XL,4XL
5.LADIES £5 PER YEAR include this in your payment
6.GUEST PLAYER-LIMITED TO SUNDAY AND WEDNESDAY CRICKET ONLY(MAXIMUM OF 2 GAMES ONLY TO BE
PLAYED FOR CLUB BEFORE PAYING MAMBERSHIP £FOC
7. SENIORS PLAYING/ JOINING LATE £35 PER YEAR
AFTER 1st JULY (no shirt included)
PAYMENT OPTIONS; CASH CHEQUE BANK TRANSFER HSBC sort code;40-43-18 account; 90785024
‘Reference with your name and subs’
I declare that the above facts are correct and that I have not signed another registration form for any other Cricket Club this season. Having read and understood the Club rules/code of conduct I agree to abide by them.I agree to take part in senior matches and do so at my own risk.
Signature…………………………….…………………………. Date ……………………
Please make a note of any relevant medical conditions that we should be aware:
………………………………………………………..…………………………………………………………….
In the event that I am injured while playing cricket or travelling to and from cricket events, I hereby give my consent to receive medical attention. (TO BE FILLED IN BY EVRYONE)
Signed……………………………………….. Print…………………………………………….Date………………..
In the event of an emergency, Please give a contact below.
1)Name…………………………………………….…..Relationship………………………………………….…...
Tel no 1………………………………………………… .Tel no 2…………………………………………………………..
APPLIES TO ALL
Please notify the Cricket Club if you change your address, Telephone numbers or E-mail. Thankyou.