Shireshead & Forton Cricket Club
Senior Membership Form (over 18) 2021

Please complete this membership form and return with the appropriate membership fees

PERSONAL DETAILS
Name
Gender
Address
Home Telephone Number
Mobile Telephone Number
Email Address
Date of Birth
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DD
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Spouse & Dependant Details for Family Membership if paying full senior membership
MEDICAL DETAILS & CONSENT
Family Doctor Address
Family Doctor Telephone Number
Emergency Contact Name
Emergency Contact Tel. Number
Emergency Contact Tel. Number
I give my consent that in an emergency situation, the Club may act if the need arises for the administration of emergency first aid and / or other medical treatment which in the opinion of a qualified medical practitioner may be necessary.
Membership Fees:
Preferred payment is online: Sort Code 40-27-02, account number 51847597. Please reference with your name & 'annual subs'.
DECLARATION & CONFIRMATION
Your personal details will be held in accordance with the EU/UK General Data Protection Regulation (GDPR) 2018.
I confirm that the information I have provided is accurate.
I confirm that I agree to abide by the various codes of conduct including the “Spirit of Cricket” operated by S&FCC. These codes of conduct are available both on the Club House Notice Board and S&FCC website. I also agree to abide by UK Government COVID Guidance. https://shiresheadandfortoncc.co.uk/
Signed
Date
MM
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DD
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YYYY
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