Senior Membership Form 20-21
All members are required to complete a membership form each season. Information you provide allows us to keep you informed about training, fixtures and club social events.
Membership renewals are due on 1st September with payment arrangements confirmed by 1st September .
Failure to pay on time will result in you being excluded from team selection.
All details will be kept in a secure database with access restricted to authorised club officers only.
Any members under the age of 18 should be completing the under 18 Membership Form.
PLEASE NOTE: IF YOU WANT TO PAY BY INSTALMENTS THE FIRST PAYMENT IS DUE BY 1st SEPTEMBER 2020.
If you have any questions about membership or payment of fees please contact Julia Johnson or Oliver Thornton.
Email us at
or come and speak to us at training.
SECTION 1: YOUR DETAILS
Date Of Birth (Month/Day/Year)
Address Line 1
Address Line 2
Telephone Contact Number
Name of previous club (new players only)
SECTION 2: MEMBERSHIP CATEGORY & PAYMENT METHOD
We have 6 membership categories and you choose the one that suits you best. You can pay for the whole year in full or in two instalments (one in September and another in January). We also have an option to pay in smaller instalments by standing order if you prefer (due on the first day of each month). If you would like to take up that option please contact the membership secretary using the
Social Membership Only
SENIOR MEMBERSHIP - £120 - 1 payment of £120 or 2 instalments of £60
FULL TIME STUDENT /REGISTERED UNWAGED - £100 - 1 payment of £100 or 2 instalments of £50
SOCIAL - £30 - 1 payment of £30
Mid-Season Joining Member - please contact Membership secretary to arrange payment schedule
COVID-19 Joiner - pay £4 training + any match fees
Do you want to pay in full or by instalments?
Please select all the relevant options from the list below. We will send you bank details as appropriate when we receive this form.
Pay FULL AMOUNT
Pay in 2 INSTALMENTS (September and January)
Other - (see membership secretary)
How would you like to pay?
Pay by BANK TRANSFER
Pay by CASH or CHEQUE
Pay by STANDING ORDER - (INSTALMENTS ONLY)
SECTION 3 EMERGENCY CONTACT DETAILS & MEDICAL INFORMATION
Emergency Contact name
Emergency Contact phone number
Relationship to you
Players are responsible for ensuring that they are physically capable of full participation in all activities
If you would like information about a medical condition, allergy and medication and an emergency contact to be made available to team captains and coaches you can provide details here. If applicable please indicate what remedial action should be taken at the onset of the problem
REFER A FRIEND - Name of new member or members making referral
Any full paying member that refers a new full paying members to the club will mean both members receive half price membership for the season. Please ensure you pay your full first instalments to receive the second instalment for free and ensure you have listed the name of the new member below, or if you are the new member, the name of the member that referred you to the club.
SECTION 4: MEMBERSHIP DECLARATION
Please tick to confirm that you agree to the statement below:
The Code of Conduct and Disciplinary Code are available on the club website
They can be found on the downloads page, on the navigation links at the top of the website.
I have read and agree to abide by the Lymm Hockey Code of Conduct and Disciplinary Code
Looking after your data
As per our data protection policy and data privacy notice available on our website, we only collect and securely store data that you provide to us. All of our data is stored using secure, online storage. This data is only shared for League Registration and England Hockey Affiliation purposes where your name and date of birth is provided as necessary to the relevant parties. All contact details and emergency contact details are shared with relevant people within the club to ensure the smooth organisation of events and the safeguarding of all of our members. Lymm Hockey Club will use your email address to contact you and update you with club news and marketin. Lymm Hockey Club will never provide your contact details to any third parties without gaining your prior consent.
I agree for LHC to use my data as per the above statement.
Please check through your details and then click the "SUBMIT" button below to send us your application. The confirmation reply that you receive will include the details you need to arrange payment and other useful information and contacts for the new season.
If you have any problems or have any questions please get in touch - you can email us at
Send me a copy of my responses.
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