All prospective members of Bishop Auckland Table Tennis Club are required to complete this registration form and return
it with payment.
All details will be kept in a secure database with access restricted to authorised officers only.
SECTION 1: CONTACT INFORMATION
TITLE
Mr
Mrs
Miss
FIRST NAME
Ms
Dr
SURNAME
MAIN TELEPHONE
ADDRESS
MOBILE PHONE:
PRIMARY EMAIL
TOWN/CITY
DATE OF BIRTH
POST CODE
Parent /Guardian
Name (if under 18)
CAN WE EMAIL YOU CLUB
NEWS
YES
NO
Parent /Guardian
Number
SECTION 2: MEDICAL INFORMATION
EMERGENCY CONTACT
CONTACT NUMBER
RELATIONSHIP
MEDICAL CONDITIONS - Please
detail any important medical
information that our coaches
should be aware of (e.g.
epilepsy, asthma, diabetes etc.)
SECTION 3: DISABILTY
The Disability Discrimination Act 1995 defines a disabled person as anyone
with ‘a physical or mental impairment, which has a substantial long-term
adverse effect on his or her ability to carry out normal day-to-day activities’.
DO YOU CONSIDER YOURSELF
TO HAVE A DISABILTY
YES
NO
If yes, what is the nature of
your disability?
Please detail below any
important medical
information that our
coaches should be aware of
VISUAL IMPAIRMENT
HEARING IMPARMENT
PHYSICAL DISABILTY
LEARNING DISABILTY
MULTPLE DISABILTY
OTHER
OTHER LISTED
SECTION 4:ETHNICITY
In order to help the club monitor its membership please will you tick one of the following boxes to identify your ethnic
group/origin.
White
Mixed
Asian or Asian British
BRITISH
IRISH
Black or Black British
CARIBBEAN
AFRICAN
WHITE AND BLACK CARIBBIAN
WHITE AND ASIAN
WHITE AND BLACK AFRICAN
PAKISTANI
BANGLADESHI
INDIAN
Chinese or other
ethnic group
CHINESE
OTHER
Other
SECTION 5: MEMBERSHIP TYPES AND FEES
Please select membership type
INCLUDES


Adult Membership
Adult Renewal
Junior Membership
Junior Renewal
Family Membership
Family Renewal
Tick
Cost

Match shirt (RRP£45)
Chance to play for Bishop
Auckland TTC teams
Table Tennis England
Membership
Discounted session fees

As above without new Shirt
£20


£40
Per year

Match shirt (RRP£45)
Chance to play for Bishop
Auckland TTC teams
Table Tennis England
Membership
Discounted session fees

As above without new Shirt
£15

For families who have more
than one family member in
the club
£35 per
member

As above without new Shirt
£10 per
member


£45
PER YEAR
Cheques to be made out to Bishop Auckland Table Tennis Club
SECTION 6: CLUB KIT
Within the membership fees there is a club shirt. The club has got discounted rate from Bribar Table Tennis.
SHIRT SIZE
Please Circle
Men’s Shirt
Lady’s Fit Shirt
(pink)
NAME TO BE PRINTED
*PLEASE NOTE ONCE THE SHIRT IS PRINTED, SIZES CAN NOT BE CHANGED PLEASE SEE MATT PORTER IF
UNSURE OF THE SIZE.
The club, through Matt Porter, can get discount at Bribar Table Tennis on Table Tennis products including bats, balls,
clothing and bags. If you wish to order anything please use the club order form.
SECTION 7: Team Interest
Please tick if you would be interested in playing in any of the below teams
Local League
National Cadet League
National Junior League (under 18s)
Club Matches vs other clubs
SECTION 8 MEMBERS SIGN OFF
I agree to abide by the Rules and the Code of Conduct of Bishop Auckland Table Tennis Club, showing respect and
consideration for other people and the Club's property. Please note: all annual members agree, as part of this application, to
wear the official BATTC shirt when representing the club in competition
…………………………………………….
Date ………………………..
If under 18 parents or guardians
I agree to let Bishop Auckland table tennis club to keep the Emergency and medical information in a file in attendance at all
sessions run by the club. Only to be used in emergency or medical situations.
I agree to let the Bishop Auckland table tennis club to use photos of my child in publicity (local newspaper, other
promotional articles and the club’s website) and training/coaching purposes in accordance with the bishop Auckland table
tennis club’s Safeguarding and Protecting Young People and consent to the above information being made available to the
Table Tennis England.
…………………………………………….
Date ………………………..