Rishworth Sports Club Application Form 2012
Title ______
First Name(s) ___________________ Surname_________________ Sex __
Address ___________________ DOB _______________________
___________________
___________________ Tel __________________________
___________________ Mob _________________________
Post Code ___________________ Email __________________________
Family Associate Member Name (Including Membership Category)
Partner Associate Member Name 2_______________________
2_______________________
3_______________________ 5_______________________
4_______________________ 6_______________________
Office Use Only
|
Membership |
Junior |
Adult |
Partner |
Family |
|
Racquet |
£65 |
|||
|
Swim |
£35 |
£150 |
£230 |
£285 |
|
Gym |
£75 |
£230 |
£385 |
£520 |
|
Club |
£85 |
£310 |
£500 |
£620 |
| Off Peak Gym |
£60 |
£170 |
£310 |
£455 |
| Off Peak Club | £70 | £265 | £440 | £555 |
Membership No’s Payment Type
1) __________
2) __________ Cash / Cheque / Credit Card / Debit Card
3) __________ / Direct Debit
4) __________
5) __________
6) __________ Amount £_________