KCC Senior/Social Application Form 2018
Membership Form for KCC Seniors
Email address *
Full Name *
Please enter your full name
Your answer
Address *
Please enter your address with comma's between each line
Your answer
Post Code *
Please enter post code with a space in the middle
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Home Tel.
Your answer
Work Tel.
Your answer
Mobile No.
Please enter a mobile number
Your answer
Preferred Contact *
Preferred Selection Contact Method *
Emergency Contact Name
Your answer
Emergency Contact Number
Your answer
Provide details of any medical conditions that the Club should be aware of (Optional): *
Please enter "None" if no medical conditions or you do not wish to declare
Your answer
Predominant Skill Level and further details: (Please tick all appropriate boxes)
Playing Preferences: (Please tick all appropriate boxes)
Please tick the box below to agree to club policies *
Required
If paying by bank transfer, please use your name as the reference and tick the box below. Sort Code: 30-94-55 Account Number: 00169502
Membership Type *
Required
Name of Junior (For Free Social Membership)
Your answer
Would you like to sponsor a match ball this year? *
Intended Payment Method *
Please make every effort to pay as soon as possible
Required
Make sure you keep up to date
Please make sure you sign up to the club website. Also, please like our Facebook page, follow our twitter page and sign up to the mobile app. Details are all on the website.
Please be advised that information provided on this form may be stored on a computerised system for use by Kesgrave Cricket Club and in accordance with the latest Data Protection Act.
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