BECROFT PARK TENNIS CLUB

"Your Club"

MEMBERSHIP APPLICATION 2011/2012

Post completed form to BPTC, PO Box 100673, NSMC

For enquiries ph: Don Johnstone on 4430329 or

Bruce Parker on 4156751

MEMBER (Existing / New) Tick if playing Interclub
Surname________________ First Name____________________

Date of Birth______________ Male Female

Postal Address_______________________________________________________

Phone_________________Business____________________Mobile_______________

Email_______________________________________

FAMILY INCLUDED IN MEMBERSHIP
Name_________________________DOB________________________ M/F Interclub

Name_________________________DOB__________________________M/F Interclub

FEES If paid before 30th September 2011 If paid after 30th September

Senior $240 $290

Married Couple $435 $485

Child of Married Couple up to 15 years $65 $95

Student 15+ as at 31st Dec 2011 $155 $205

Junior 11-15 as at 31 Dec 2011
Junior up to 11 as at 31 Dec 2011
$135
$125
$185
$160

Social Member Interclub not applicable $135 $185

Interclub fee, Senior/Student
Singles or doubles
$69

If playing both singles and doubles $84

Interclub fee Junior
Interclub fee juniors 11-14 & Students 15+

$35
$40

PAYMENT DUE: Add fees from table above	PAYMENT METHOD
$________________Membership fee $________________Senior/Student Interclub fee $________________Junior Interclub fee $________________Court access key (if required $20) $_______________Total Payment	Cash š Cheque š Direct Credit š Internet Banking to: ASB 12 3050 0470127 00 Enter name and sub as reference
SIGNATURE DATE

As an Incorporated Society, we are legally required to collect this information. Unless otherwise requested your details will be listed in the clubs membership records and the above information will be forwarded to Tennis Northern for their records. If provided, your email address will be used to send newsletters and Club information periodically. You have rights under the Privacy Act 1993 to access, and to the correction of this information

	MEMBERSHIP APPLICATION 2011/2012 Post completed form to BPTC, PO Box 100673, NSMC For enquiries ph: Don Johnstone on 4430329 or Bruce Parker on 4156751
MEMBER (Existing / New) Tick if playing Interclub Surname________________ First Name____________________ Date of Birth______________ Male Female Postal Address_______________________________________________________ Phone_________________Business____________________Mobile_______________ Email_______________________________________

FEES	If paid before 30th September 2011	If paid after 30th September
Senior	$240	$290
Married Couple	$435	$485
Child of Married Couple up to 15 years	$65	$95
Student 15+ as at 31st Dec 2011	$155	$205
Junior 11-15 as at 31 Dec 2011 Junior up to 11 as at 31 Dec 2011	$135 $125	$185 $160
Social Member Interclub not applicable	$135	$185
Interclub fee, Senior/Student Singles or doubles	$69
If playing both singles and doubles	$84
Interclub fee Junior Interclub fee juniors 11-14 & Students 15+	$35 $40