2016 Membership Application Form

(If renewing membership only complete details if updating required from last year)

Name:
Title / First Name / Last Name
Date of birth: / _ _ / _ _ / _ _ _ _ / Gender / Male  Female 
Address:
House Name/number
Address Line 1
Address Line 2
Town/City
County / Postcode
Contact numbers: / Home
Mobile
Email address
Tick if you do not want to receive non-tennis information from Pocklington Tennis Club

Declaration

By signing and returning this form, I agree to abide by the constitution of Pocklington Tennis Club and adhere to the tennis dress code at all times. No black soled trainers or jeans.

Signed: ………………………………………………………… Date: _ _ / _ _ / _ _ _ _

Name (Please Print)…………………………………:……………………………………………………………..

Membership of the LTA (British Tennis) is free so please take advantage of the benefits of British Tennis Membership. For more information visit: In order that we meet the LTA guidelines, please complete the membership form, one for each person wishing to join.

NB Where there is a joint Adult and Junior application, please send all forms and payment to the above address.

Payment

Full Adult membership only can be paid by standing order in 12 equal monthly instalments of £11 per month per adult commencing no later than 31 March 2016. A standing order form is available on the club website (pocklingtontennis.com) or obtainable by request from the Membership Secretary. If you wish take advantage of this method of payment and gain the ‘family discount,’ please adjust the junior payment accordingly. There is no facility to pay junior membership by standing order.

Alternatively, membership can be paid by a one off payment for the amount listed below. (Usually paid by cheque)

If you wish to make payment for more than one member, please fill in the table below on the first applicant’s form. All members are requested to fill out a separate Membership Form, (downloadable from the club web site in the ‘Membership section’) if they wish to take advantage of British Tennis Membership. Those under 18, please state date of birth.

There is a Family concession for 4 or more members- 10% discount.

Name/s
Adult / £132
Adult > 65 yrs at 1 April 2016 / £105
Parent Adult (Restricted Playing Rights – Family Only Play) / £66
Intermediate (17- 25 years)
(Unless in full time employment - Adult Sub Due) / £60 / DOB
Junior (10-16 years) / £45 / DOB
Junior (under 10 years) / £20 / DOB

In the space below, please write in full your payment, e.g. £132+£132+£60+£45=£369-£36.90=£332.10

Payment:
Total paid

Please note that members are only entitled to enter the club Wimbledon ticket draw if they are members of LTA British Tennis. Membership of LTA British Tennis is free for club members. We recommend that all members of the club including juniors should join British Tennis so that our Wimbledon ticket allocation is increased. To join British Tennis, please visit You can register as a British Tennis member for free so please do not delay in visiting their website and completing your registration details.

Return the form/s, with a cheque payable to Pocklington Tennis Club to:
Pocklington Tennis Club Membership Secretary, Dave Maultby, 5 The Courtneys, Wheldrake, York, YO19 6BR
Phone 01904 449595 Mobile 0787 2606221 Email:

standing order mandate

To Bank PLC

Address

bank / branch title (not address) / sorting code number
Please Pay / NatWest / Pocklington / 60 - 16 - 35
beneficiary's name / account number
For the Credit of / Pocklington Tennis Club / 7 / 7 / 7 / 5 / 9 / 0 / 6 / 0
amount in figures / amount in words
The Sum Of / £ / 11.00 / Eleven Pounds only
date and amount of first payment / due date and
Commencing / 2016 / £11.00 / frequency
and thereafter every / 20th Monthly
date and amount of last payment
*until / Until further notice / £ / *until you receive further notice from me/us in
writing
quoting the
reference / and debit my/our account accordingly

This instruction cancels any previous order in favour of the beneficiary named above, under this reference.

Special Instructions
None
account to be debited / account number

Signature(s) Date

Note:The Bank will not undertake to:

(i)make any reference to Value Added Tax or other indeterminate element.

(ii)advise payers address to beneficiary.

(iii)advise beneficiary of inability to pay.

(iv)request beneficiary's banker to advise beneficiary of receipt.

*Delete if not applicable

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