Lesmurdie Tennis Club (Inc)
NEW MEMBERSHIP APPLICATION FORM
MEMBER DETAILS (Please note details below are required)
Title: ________ First Name: _______________________________ Last Name: _____________________________
Gender: Male ☐ Female: ☐
My Tennis ID (If known) __________________________________________
Mailing Address: _______________________________________________________________________________
Telephone No: ________________ Mobile No:___________________Email: ______________________________
Date of Birth: (Juniors compulsory) ____/____/_____or Age Range: 18-29, 30-44, 45-59, 60+ (please circle)
MEMBERSHIP TYPE (membership rates 1 July to 30 June each year)
Category
Rates
Number Amount
Senior Membership
$110
Family 1 Senior + 1 or (more)Junior/Student
Senior rate
($110) + $35 per
Junior/Students
Junior (under 18 years)
$60
Full Time Student (18-25 years
$60
Senior Associate-one season of pennants $50
summer/winter (Tennis West/Central Hills/SSTA)
Junior Associate-one season of Pennants $40
summer/winter (Tennis West)
Non Playing Member
$40
Gate Key
$10
PAYMENT DETAILS
☐Cash – Handed to: ____________________________________________________________________________
☐Cheque No: ____________________________ Handed/posted to: _____________________________________
☐Electronic Funds Transfer Lesmurdie Tennis Club (Inc.) BSB 016341 Account No. 370234349. Receipt: _________
FAMILY DETAILS (Other members on same application)
First Name
Last Name
My Tennis ID Gender Date of Birth
Family Member
M/F
(Head, Spouse, Child)
TERMS, CONDITIONS AND PRIVACY (Tennis Australia)
I acknowledge that as a member of Lesmurdie Tennis Club, my (and my family) personal details will be recorded on Tennis Australia’s online
My Tennis database and you agree to the terms, conditions and privacy policy which can be found at www.tennis.com.au/privacy
Marketing and Communications
☐ I do not wish to receive communications and direct marketing from Lesmurdie Tennis Club;
☐ I do not wish to receive communications and direct marketing from Tennis West;
☐ I do not wish to receive communications and direct marketing from Tennis Australia;
☐ I consent to Lesmurdie Tennis Club taking, retaining and reproducing my image obtained during my participation in any tennis activities in
photographs and electronic images for the purposes of any Lesmurdie Tennis Club promotional, advertising, research or marketing.
Signature: ______________________________ Date: ___/___/___
( Parent/guardian’s name if player is under 18 years of age)
(Club use only)
Membership application approved at ___/____/____ meeting.
Welcome letter sent ____/___/_____.
Lesmurdie Tennis Club (Inc.) / PO Box 91 Kalamunda WA 6926 / 22 Falls Road, Lesmurdie / Telephone 9291 8274 /
Email: secretary@lesmurdietennisclub.com.au / Website: www.lesmurdietennisclub.com.au