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.