MANDATORY INFORMATION REQUIRED FOR AFFILIATION – Please complete in BLOCK CAPITALS
Membership Number (if applicable)
Affiliation Type:
(Please tick) / Player/Coach/Umpire / Social & Supporter/Volunteer
Surname: / Forenames:
Home Address:
Postcode: / Email:
Phone Numbers: / H: / M:
Date of Birth: / DD/MM/YYYY
Gender:
(Please tick) / Male / Female / Transgender: (Please tick) / Yes / No / Prefer Not to say
Ethnicity
(Please tick as applicable) / Religion
(Please tick as applicable) / Disability
(Please tick as applicable)
As defined by the 2011 Census / Christian
(including Church of England, Catholic, Protestant and all other Christian Denominations) / Do you consider yourself to be disabled under the Equality Act 2010? The Equality Act 2010 defines a person as disabled as an individual that has a physical or mental impairment that has a substantial and long-term negative effect on their ability to carry out normal activities
White – British
White – Irish
White – Gypsy or Irish Traveller
White – Other White Background
Mixed – White & Black Caribbean / Buddhist
Mixed – White & Black African / Hindu
Mixed – White & Asian / Jewish
Mixed – Other Mixed Background / Muslim / Yes / No
Asian or Asian British - Indian / Sikh
Asian or Asian British - Pakistani / Any Other Religion / Blind or Visually Impaired
Asian or Asian British - Bangladeshi / No Religion / Deaf or Hard of Hearing
Asian or Asian British – Other Asian Background / Prefer Not to Say / Physical Impairment
Asian or Asian British - Chinese / Sexual Orientation
(Please tick as applicable) / Learning Disability
Black or British – Caribbean / Social or Behavioural
Black or British – African / Mental Health
Black or British – Other Black Background / Heterosexual / Straight / Multiple Disabilities
Other / Gay Man
Prefer Not to Say / Gay Woman / Lesbian / Any Other Impairment
Bisexual / Prefer Not To Say
Other Sexuality
Prefer Not To Say
DATA PROTECTION:England Netball, your Region(s) and County(s) will use your personal data (including potentially sensitive data) for the purpose of your participation in Netball, for regulatory reasons and to provide you information about Netball.
Tick here if you would like England Netball & our Partners to tell you more about our netball news and offers by email
AFFILIATION DECLARATION: I certify that all the information is correct and agree to abide by the laws of the game and England Netballs rules, regulations and disciplinary requirements.
Signature / Date

GALMINGTON NETBALL CLUB

2017/18 MEMBER REGISTRATION FORM

Member Name
I agree to the Club Code of Conduct(dated June 2015) / I Agree and understand this applies to myself as a player, coach, umpire and/or supporter, as well as to parent/s, guardian/s or supporters associated with me.
Registration Type (please tick 1box)
See table on page 3 for registration type key / Senior Senior FTE Senior Part Time
Junior High 5
Juniors/H5: School Year at 1/9/2017 / Year
Email Address /
Emergency Contact Details / Name: ______
Mobile Phone:
Home Phone:
Medical Information (e.g. Asthma)
This is kept in Club kitbags for emergency purposes, and is not confidentially stored
Playing position/Saturday availability / Playing Position/s Saturday Availability
U18s Only: Parent/Guardian name
U18s Only : Consent for filming/photography according to Club regulations (dated June 2010), go to / Parent/Carer: I ______give consent to GNC for photographing/ videoing ______
Date: ______Signed:______
U18Member: I ______give consent to GNC to photograph or video my involvement in netball.
Date: ______Signed:______
Member Signature
To be signed by Parent/Guardian if U18
Payment Details
Please enter amount per cheque/s / Total £
Cash £ Cheque/s £ £ £ £

By agreeing to affiliate with England Netball Galmington Netball Club, you are agreeing that the information you have provided on these forms will be available to GalmingtonNC, Somerset County Netball Association, Netball South West and England Netball. Please tick to show you have read and agreed to this:

(For Club Use Only)

Total Received £ Date Received ___/___/____ Affiliation No. ______Affiliation Amount £

Cash £ Cheque 1 £ Cheque 2 £ Cheque 3 £ Cheque 4 £ Cheque 5

Pay in Refs

MEMBER REGISTRATION INFORMATION - SENIORS 2017/18

  • You must FULLY complete the England Netball Registration Form appropriate to your age group or your membership cannot be accepted.
  • To return your registration, please post to Beth Blackwell, Senior Membership Secretary, Sloe Tree House, Staplehay, Trull, Taunton, TA3 7HD
  • If handing your form & money to a Club representative, please put in a sealed envelope with players name on the front.
  • We cannot accept emailed forms or incomplete forms – these will be rejected.

REGISTRATION TYPE AND ANNUAL SUBS

Registration Type / Training Sessions / Annual Subs
Senior / Senior / £160
Senior in Full Time Education / Senior / £135
Senior – Part Time member / Senior / £70
  • New members are entitled to 3 free training sessions. Anyone who has previously affiliated with the club is due annual subs from the date of the first training session they attend that season.
  • Part-time senior players will NOT be eligible to be categorised into a team, and attendance at training sessions will be £4 per session, payable on the night.

Registration Type
Joining Date / Aug / Sept / Oct / Nov / Dec / Jan / Feb / Mar / Apr
Senior / £160 / £160 / £160 / £160 / £160 / £100 / £85 / £70 / £55
Senior FTE / £135 / £135 / £135 / £135 / £135 / £83 / £70 / £57 / £44
Senior Part Time / £70 / £70 / £70 / £70 / £70 / £55 / £52 / £48 / £44

PAYMENT TERMS

Full payment must be submitted with membership forms (Cheques made payable to “Galmington Netball Club” with players name written on the back) in one of the following ways:-

Senior Player - One cheque for the full amount or 5 payments of £32.00 from August by postdated cheques

FTE Player - One cheque for the full amount or 5 payments of £27.00 from Augustby postdated cheques

Part Time Player- One cheque for the full amount or 1 payment of £35.00 in August and 1 payment of £35.00 in September by postdated cheque

Bank Details Account - Galmington Netball Club

Account no - 10160812

Sort Code - 16-33-16

All postdated cheques to be received during August and if no monies received by 31st August then the player is not allowed to train or play in games as that is the date their insurance expires

WHAT DO YOUR ANNUAL SUBS COVER?

  • Affiliation to England Netball (and free quarterly netball magazine), Somerset & Regional Leagues.
  • Civil Liability and Personal Accident insurance.
  • Coaching fees, Court Hire and Equipment

WHAT IS NOT COVERED BY ANNUAL SUBS?

  • Match fees and kit expenses are not included in annual subs (all players are expected to provide their own kit for matches)
  • The senior squads for Galmington, Trident and Hovelands are also required to pay a nominal indoor training fee, which is non refundable

REFUNDS

Refunds are at the discretion of the Committee and will only be made in rare or exceptional circumstances. Requests should be made to the Membership Secretary (Beth Blackwell), who will raise with the Committee.

Please note that Galmington Netball Club are charged an affiliation fee by England Netball, Somerset & Regional Netball Associations, which is non-refundable to members.