GXLTC
Bull Lane
Gerrards Cross Lawn Tennis Club
and British Tennis Membership Form 2014 - 2015
To become a member of GXLTC (which includes free British Tennis Membership), please complete
this form and return to GXLTC, Bull Lane, Gerrards Cross, Bucks, SL9 8RN marking the envelope
‘Membership’, or e-mail to info@gxltc.co.uk. For methods of payment see attached sheet. Should
you have a query, please contact the Administrator on 07875 604872 or e-mail info@gxltc.co.uk.
Membership Category:
Application Date:
Total paid:
In the space below please write the name of the existing
member who was instrumental in encouraging you to join.
(If not applicable please cross through).
Method of payment:
Members Details: (DOB if under 25)
Address:
Surname:
First name:
Date of birth:
First name:
Date of birth:
Postcode:
First name:
Date of birth:
Tel no:
Mobile no(s):
First name:
Date of birth:
First name:
Date of birth:
Occupation(s):
E-mail address: please insert one character in each box
School (if applicable):
Please let us know if you would be willing to help with the running of the club. Any offers of help are greatly
appreciated
Social / juniors / club evenings / match fixtures / competition organiser
Are you disabled*? Please circle one
yes
no
prefer not to say
*The Disability Discrimination Act (DDA) 1995 defines a disabled person as someone who has a physical
or sensory impairment that has substantial or long term adverse effects on his or her ability to carry out
day-to-day activities.
Would you like an LTA player rating?
Membership categories:
Full member: £335
Husband & Wife: £540
Family (Couple & children in full time
education): £685
Off Peak (Mon-Fri >5.30pm): £230
Over 65 (Single): £245
Over 65 (Husband & Wife): £365
University: £115
U25 (on 1.1.14): £205
Over 65/Under 65 (Husband & Wife): £445
Non-playing (Social): £35*
U18 (on 1.1.14): £155
U14 (on 1.1.14): £115*
U10 (on 1.1.14): £75*
U8 (on 1.1.14): £45*
* U8s & U10s must be
supervised at all times. No play
after 5.30pm except Fridays when
extended to 6.30pm.
Under 8s,10s and 14s,
must have at least one
parent or guardian as a
playing or social
member.
GXLTC
Bull Lane
British Tennis Membership is the LTA's scheme for individual participants in tennis. As Gerrards
Cross Lawn Tennis Club is affiliated to the LTA, by joining the Club, you also become a British Tennis
Member at no additional cost. The benefits of British Tennis Membership include entry into the club
ballot for Wimbledon tickets; a player rating; a TeamCard (which is a way of collecting points when
you shop which you can redeem against tennis equipment) and discounts on tennis tickets (e.g.,
Davis Cup). ….to name a few.
Data Protection Statement
By signing this form, you agree that the Club and the LTA and its National, County and Channel
Island Associations can use your personal data, including sensitive personal data, for membership
purposes and to send you by post or email or SMS information related to those purposes. For further
details please see www.lta.org.uk/privacy.
To help us raise funds for tennis, the LTA may also wish to do the following (please tick the
appropriate the box if you do not want us to):
● send you information about LTA offers and about offers from 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 □
Terms and conditions
The Terms and Conditions of British Tennis Membership can be accessed at:
www.lta.org.uk/BritishTennisMembership/Termsandconditions.pdf or from your club secretary.
The Club Rules are available at www.gxltc.co.uk or in the Clubhouse.
By signing below I agree to:● Become a member of Gerrards Cross Lawn Tennis Club and British Tennis Membership
● Abide by the Club rules and the terms and conditions of British Tennis Membership
● The Data Protection Statement above
Signature
Signature of parent or guardian (if under 18)
EQUALITY AND DIVERSITY MONITORING
The LTA and its affiliated clubs are committed to making tennis accessible to all. The questions below
are designed to help us monitor the effectiveness of our Equality & Diversity Policy, and assist us in
our progress towards identifying any barriers to diversity.
You do not have to answer any of the questions below, but the more information you supply the more
effective our monitoring will be. All personal data supplied on this part of the form will be processed
by the LTA and the Club in accordance with the Data Protection Act 1998 and used for monitoring
purposes only.
How would you describe your ethnic origin? (Please circle one option)
White – White-English; White-Irish; White-Scottish; White-British; White-Welsh; other White
background.
Mixed – White & Black Caribbean; White & Black African; White & Asian; Mixed Background.
Asian – British-Indian; Indian; British-Pakistani; Pakistani; British-Bangladeshi; Bangladeshi.
Black – British-Caribbean; Caribbean; British-African; African.
Chinese – British-Chinese; Chinese.
Other background – other.
Undeclared – Undeclared.