Membership Application 2021/2022

Membership Applications are now being accepted for the 21/22 Season.

Substantial Early Bird Discounts apply on payments made prior to 31 March 2021

All Applications need to be made on line using the Form below and be paid using our secure Paypal on Line payments system which accepts all main stream Credit cards in addition to Paypal accounts.

If you have any queries relating to on line application or Paypal payment please contact the Treasurer on 07973 624726.

Applicant Name *

First

Last

This should be the name of the proposed member NOT the name of the Parent or Guardian in the case of a junior (see Below)

Applicant Title *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Email *

Confirm Email

This email address will be the principal means for the Club to contact you with all club information. Your email will not be disclosed to third parties without your consent. if you do not have an email or wish to be contacted by other means please contact the Club Secretary direct-See Contact Us tab on our web site.

Membership category applied for *

Junior (Parental Consent Required)
Senior

Juniors must be Under 16 as at 1 April 2021. Membership-Junior £15-Senior £20. An early Bird Reduced Rate which is currently available saves £5 on Memberships bought in advance.

Date of Birth (JUNIORS ONLY)

Please enter in the format dd/mm/yyyy

Parent/Guardian Name (JUNIORS ONLY)

First

Last

Emergency Contact Number *

Payment Using Secure Paypal Account *

Junior £15
Senior £20

Pay by Paypal using a Credit card or Paypal account

Acceptance / Parental Consent *

Accepted

I agree that I, and where appropriate, the junior member listed on this form will comply with Wrekin North Riding Club Rules. I also confirm that I have parental responsability for any junior listed on this form

Name

Wrekin North Riding Club

Membership Application 2021/2022

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