COMBERTON VILLAGE COLLEGE SQUASH CLUB
MEMBERSHIP APPLICATION 2012/2013
Member Details
Title
Forename*
Surname*
Telephone*
E-mail*
Dr/Mr/Mrs/Ms/Mstr/Miss (Delete)
Date
Address
Postcode
*Note that the above information will be circulated to existing members of the club for the purpose of arranging matches.
Membership Type
Month renewed/joined circle amount paid in box
Sep Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul Aug
156
140
125
109
94
78
62
47
31
91
82
73
64
55
46
36
27
18
91
82
73
64
55
46
36
27
18
52
47
42
36
31
26
21
16
10
91
82
73
64
55
46
36
27
18
Junior:** - U11 supervised
26
23
21
18
16
13
10
8
5
Family ***
Corporate
247
222
198
173
148
124
74
49
354
318
283
248
212
177
141 106
71
Full Adult
Full Student:*
Full Under19:**
Full Under16:**
Day – restricted booking
99
*** Family can be one or both parents and any number of their offspring (U19 or student in full time education).
Use reverse of form to list names, email addresses and date of birth of the offspring.
* STUDENT - copy of student card required
**UNDER 16’s/U19’s date of birth required ___/___/___
Full Membership for under 16's can only be accepted on the condition that a Parent or Guardian is prepared to
accept responsibility for the conduct of the individual whilst on Comberton Village College Squash Club
premises. A Parent or Guardian should complete the following declaration: ‘I am aware that full membership
grants access to the Comberton Village College Squash Club premises at all times and supervision is not
provided.’
Signed as Parent/Guardian _________________________________(Print Name)__________________________________
CLUB LEAGUES – I wish to join the internal leagues YES / NO
E ENGLAND SQUASH
Registration Number (if known)_____________
The Club will register and renew membership of England Squash for Full Members whose renewal
is received by 30th Sept. After this date Members must arrange their own registration.
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Return this form, together with your subscription cheque (and key deposit if applicable – see below) made
payable to COMBERTON VILLAGE COLLEGE SQUASH CLUB, to:
Derek Fuller, Walnut Lodge, Shedbury Lane, Bassingbourn, Royston, SG8 5PH
If you are a new member enclose a STAMPED SELF-ADDRESSED ENVELOPE and £5 returnable deposit
to receive an electronic key fob to the club. (NOTE the stamp should be for Large Envelope due to the
thickness of the key, although the envelope itself can be normal size). (this does not apply for Junior U11
Supervised members who are not issued with keys and cannot book courts as the ‘first player’)