Olton & WW - Application Form 2010-2011

I wish to apply for membership of Olton & West Warwick Hockey Club.

I understand that completion of this form is a requirement of membership and that, if appointed,
I agree to abide by the Rules and Regulations of the Club.

Male/Female Member Section Date of Birth
      Senior / Junior / Student e.g. 25 Dec 1960
PLEASE COMPLETE ALL CONTACT DETAILS
Surname
Forenames
Address
 
 
Postcode
Home Phone
Work Phone
Mobile Phone
email Address
Preference/Privacy*
Please indicate preferred mode of contact e.g. email
* Place X as first Character if you DO NOT wish other members to see your basic Contact info - the default is that members CAN SEE other members details.
Additional Supporting Details
* Senior Males please see below
  Submission date
    4 Sep 2010
Click to post electronically ...  
If posted electronically you will be advised of payment requirents.
    Submission date
Signed
(if not Electonic) 		 

Enclosing Cheque
to the value 		 

This application form may be completed electronically at www.OltonHockeyClub.co.uk/Apply.asp - and no further action is required - you will be contacted regarding subscription payment.
If the form has been downloaded/printed and completed on paper, it should be returned to :
Clare Rippin (OltonHC Membership Secretary), 26 Maywell Drive, Solihull, West Midlands, B92 0PR
In either case, the Committee will consider your application and respond within 7 days - to your preferred contact point.
If you wish to send a cheque with any paper/postal application it should be made payable to Olton Hockey Club.
 
Membership Type Subscription Due Late Payment **
+ Senior Playing £185.00 £210.00
  Student (over 18) in Full Time Education £ 85.00 £ 95.00
* Junior Playing (under 18) £ 85.00 £ 95.00
* Mini-member (Sundays only) in lieu of weekly fee
    and First Year Vixens and Badgers 		£ 45.00 £ 50.00
  Non-Playing Social Member £ 35.00
 
** non-payment of subscriptions by 1st November for regular players will incur Late Payment charge
* members under 18 yrs of age are required to complete a Medical Form - signed by a Parent or Guardian.
+ Senior Male members must submit details of any other club represented in the last 12 months
in order to comply with League Transfer rules - a formal transfer may be required.
 
Data Protection Act. Membership of the Club and acceptance of the Club Rules by the member will be deemed to constitute consent to the holding of relevant personal data for the purposes of the Data Protection Act 1998.