ASHBY CASTLE
JUNIOR
LAWN TENNIS CLUB
Affiliated to The Lawn Tennis Association
Courts and Clubhouse: South Street, Ashby-de-la-Zouch,
Leicestershire.
Tel: 01530 414807
Benefits of Membership include:
 Use of the courts and facilities at A.C.L.T.C
 Reduced coaching fees
 Chance to represent the club in league matches
 Enter Club Tournaments and great social events
 Obtain free British Tennis membership - To
register, log on to www.lta.org.uk/membership
 Entry into the Wimbledon Ballot
Surname
First Name(s)
If you wish to pay electronically leave your name
as a reference and return this form to Lisa Sayner.
Account No: 47054778 Sort code: 60- 01- 20
Emergency Contact Details (Please print clearly)
Title
First Name
Surname
Telephone
Address
Mobile
Medical Conditions & Allergies
It would be helpful if you could advise us of any special
care needs, medical conditions, dietary requirements
or allergies please use over leaf.
Post Code
Parent / Guardian Declaration - Essential if
applicant is under 16 years of age
Date of Birth
School
• By signing and returning this form, I agree to the
applicant named taking part in the general activities of
the club.
Telephone
Mobile
Email
British Tennis Membership No
Membership runs from 31st March 2015 to 31st March
2016. Please tick the appropriate box.
Enter
Category
Fee
(To be paid by
31.3.2015)
Junior (Under10)
£30
Junior (10-18)
£55
Social Member
Parent/Guardian
£10
Parent Member
£50*
Please make cheques payable to:Ashby Castle Lawn Tennis Club and return with
completed form to:-Lisa Sayner
Lisa Sayner, 18 Lower Packington Road,
Ashby De La Zouch, Leics, LE65 1GD.
Email: - whpole@btinternet.com Mobile: 07985 020474
• I consent to him/her being included in photographs
taken informally by members or other parents at the
club if you want to reserve your permission for
special request, please tick here.
• I consent to him/her travelling with selected club
members on team and other club-related trips if you
want to reserve your permission for special request
please tick here.
• To my knowledge, he/she has no medical conditions
or allergies other than those declared on this form over
leaf.
• I understand that I must inform the club of any
changes to the information provided on this form.•
I hereby apply for membership of Ashby Lawn Tennis
Club and agree to abide by the Club Constitution and
Rules. (I understand that my application may be subject to review
and that all fees will be returned in the event of my application being
rejected).
Signature of Parent or Guardian
Name (please print)
Date