JUNIOR MEMBERSHIP APPLICATION – 2014/15
(1 April 2014 to 31 March 2015)
www.devizestennisclub.org.uk
Welcome to Devizes Lawn Tennis Club. In order to provide a safe club for all our
junior members, and to keep you up to date with club activities please complete this
form in full. Annual Fee for Juniors is £38 – free for Juniors in School Year 2 or
below on 1 April 2014. (Student Membership i.e. 19+ on 1 April 2014 use adult form).
Pay on-line to Devizes Lawn Tennis Club Sort Code 40-19-16 Account Number 31340832 or by cheque.
Please return the form with your subscription or confirmation of on-line payment to the Membership
Secretary: Karen Eustace, Brickfield Farmhouse, Coulston, Westbury, BA13 4NZ
Tel: 01380 – 831312 kanda.eustace@hotmail.co.uk
Name of junior
Renewal / New Member
member (please print)
Male / Female (delete British Tennis
Date of birth &
as appropriate)
Number
School Year
Address of child (this
will be the
correspondence
address)
Please provide details of a parent/guardian that we can contact in case of an emergency:
Name (please print)
Relationship to child
Contact numbers:
Indicate if this is
Home
Email address for
correspondence
Please note that most club correspondence is sent out by email. Please write your correspondence email address
clearly.
Mobile
Please use the box below to describe any special care needs, dietary requirements, allergies or medical
conditions:
LTA Child Protection
T: 0208 487 7008/7116
M (24 hour): 07971 141 024
Email: childprotection@lta.org.uk
www.LTA.org.uk/childprotection
Parent/guardian declaration (required if applicant is under 17 years of age)
By signing and returning this form, I agree to ……………………………………………………………………… (child’s name) taking
part in the general activities of the club. He/she has agreed to follow the junior rules of the club, and I
agree to accept the code of conduct for parents.
To my knowledge, he/she has no special care needs, dietary requirements, allergies or medical conditions
that could affect his/her safety at the club, other than those declared on this form. I understand that in
the event of any injury, illness or other medical need, all reasonable steps will be taken to contact me, and
to deal with the situation appropriately.
I understand that I must inform the club of any changes to the information provided on this form.
Photographs: Tick this box if you give your permission for the club to use photographs of your child
to promote the activities of Devizes Lawn Tennis Club
Signed (Parent or Guardian):…………………………………………………………… Date:…………………………
SEE OVER TO SIGN UP FOR FREE MEMBERSHIP OF BRITISH TENNIS
DEVIZES TENNIS CLUB – BRITISH TENNIS MEMBERSHIP
Dear Member
If you have not already taken advantage of the opportunity for FREE British Tennis Membership with
the LTA, this is a benefit which we can offer you free as a club member. British Tennis Membership
offers a number of great benefits including:
Entry into our club’s BTM Wimbledon Ballot and the opportunity to book into the BTM exclusive
suites at Wimbledon. An AEGON British Tennis Rating, which is essential to compete and allows you
to track your progress.
Monthly e-newsletter and access to Members’ only area of website to help track and manage your
tennis
Ticket discounts on a number of international events, other exclusive offers on tennis products, and
exclusive advice to help your game – to read about full benefits visit www.LTA.org.uk/membership
All you need to do to sign yourself and/or your child up to British Tennis Membership is to fill out the
form and sign below - the Club will do the rest.
 Name of affiliated club(s): If more than one then please list… Devizes LTC ……………………………
 Would you like an LTA rating?
YES / NO
By giving your consent to you/your child becoming a British Tennis Member, you agree that you/your
child will abide by the Terms and Conditions of British Tennis Membership (at
www.LTA.org.uk/BTMTC) and that the LTA and its directly affiliated bodies (see
www.LTA.org.uk/affiliatedbodies) can use the personal data of you/your child, including sensitive
personal date, for the purposes of your involvement in British Tennis, and to send you/your child by
post, email or SMS information related to those purposes (for more information see
www.LTA.org.uk/privacy)
Please sign here if you would like Devizes Tennis Club to sign you up to British Tennis Membership
for free.
Signature............................................................................................................ (Parent or Guardian to
sign if under 18)
As a British Tennis Member the LTA would like to hear what you would like from your membership, what
is happening in your tennis community and if there is any information you would like to make it easier for
you play more, watch more or compete more. To get in touch, email Info@LTA.org.uk
To help us raise funds for tennis, the LTA may also wish to do the following:

Send you information about LTA offers and about offers carefully selected third parties by
post/email/SMS.

Pass your contact details to carefully selected third parties so that they can send you, by post,
details of their products and services.