2011-2012NEW Membership Application

KALEEN AND DISTRICT TENNIS CLUB (INC.),Birie Place, Kaleen

Submit completed form to

Membership KDTC
PO Box 875, Jamison PO
MACQUARIE ACT 2614

My Tennis ID (if known)……………………………(Please use BLOCK letter)

Surname (Mr/Mrs/Miss/Ms/Dr): …………………………………… First Name: ………………...………………….

Address: ……………………………………………………………………………………..… Postcode: ……………

Telephone number: ……………..……….(H) ..………….……………(W) ……..………….………………….(M)

Email: …………………………………………………………………………………………………………………..

Single Membership (19 years +)
Family Membership (2 adults & up to 3 children between 5-19 years of age)
Name of Partner: ………………………………………………………
Child 1 – name: ………………………………………………………. / Date of Birth: …../…../……….
Child 2 – name: ………………………………………………………. / Date of Birth: …../…../……….
Child 3 – name: ………………………………………………………. / Date of Birth: …../…../……….
Junior Membership (under 19 years) Date of Birth: …../…../……….
Full-Time Student Membership (under 25 years) Date of Birth: …../…../……….

I choose to receive Newsletters via email from Kaleen and District Tennis Club

I am interested in and agree to the club contacting me in relation to the following programs and services

 TACT Pennant Coaching Club administration opportunities

Turbo Tennis Social Competitions Social activities

 Working Bees I choose to receive Newsletters via email from Tennis ACT

 I choose to receive Newsletters via email from Tennis Australia

KEYS: Adult members (and junior members 15 years & over with approval from the KDTC Committee) can receive a key to the tennis club complex with a deposit of $40.00 – refundable on return of the key.

FEES: Circle amount due and add total ~

Joining in: / Single / Family / Junior / F/T Student / Please make cheques payable to KDTC.
Direct deposits may be made to our account:
Acct name: Kaleen & District Tennis Club
Bank: Commonwealth
BSB: 062-913
Acct 0090 2374.
Please include Surname as reference in direct deposits.
Oct/Nov/Dec 2010 / $110 / $225 / $75 / $100
Jan/Feb/Mar 2011 / $85 / $165 / $57 / $75
Apr/May/June 2011 / $58 / $110 / $38 / $50
Jul/Aug/Sept 2011 / $29 / $55 / $19 / $25
Key Deposit / $40.00 / $40.00 / $40.00 (15+) / $40.00
TOTAL Payable:

New membershipsare considered by the Club’s Committee at its next meeting. Applications may take up to 4 weeks to process. Please phone Clare Thomas, Membership Secretary, on 62581464(ah), or check our website on

I/We hereby apply for membership with the ‘Kaleen and District Tennis Club’ and agree, if accepted, to be bound by the rules and by-laws of the Club.

Signature: ………………………………………..………Date: ……………………

NOMINATION: Nominated supported by …………………………………………………………..

(Name in block letters)

I am a current member of KDTC…………………………………………………..

(Signature of Nominator)

Privacy Statement

The Kaleen and District Tennis Club requires the above information for the purposes of providing membership services. As a condition of its affiliation with Tennis ACT, the Club is required to provide Tennis ACT with the personal information provided above. The information so provided will be used only in accordance with the purposes of Tennis ACT to provide membership services. Individual members can access their personal information through Tennis ACT and the Kaleen and District Tennis Club upon reasonable notice.

Club use only:
Receipt Number: / Keys: / Tags:

PTO 