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UHTennis_Club_Registration_-_2011

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					                                               tennis UPPER HUTT                                                                              37 Exchange Street
                                                                                                                                              Upper Hutt 5018
                                    (TENNIS SECTION of UPPER HUTT BOWLING & TENNIS CLUB INC)                                                  (04) 528 3255
                                 Registration Form 2011/2012                                                                                  www.upperhutttennis.co.nz


 New Member                   Renewal (tick one)

SURNAME: ____________________

FAMILY MEMBERS INCLUDED IN MEMBERSHIP

First Name:                         M/F          DATE OF BIRTH                    CONTACT PHONE                        MEMBER TYPE                   INTERCLUB
                                            (If 21yrs or under @ 30.09.11)
_______________                     _____         ____/_____/_____                _______________                      ____________                 ____________

_______________                    _____          ____/_____/_____                _______________                      _____________                ____________

_______________                    _____         ____/_____/_____                  _______________                     _____________                ____________

_______________                    _____         ____/_____/_____                 _______________                      _____________                 ____________

HOME ADDRESS: ________________________________________________________

EMAIL ADDRESS: ___________________________________________________

*Early payment discount only applies to senior subscription fees if paid by 30th September 2011.
                                                                                                                Fee
                  MEMBERSHIP TYPE                                                  Fee                      (incl. GST)                Qty                 Amount Due
(Subscription includes affiliation fees to Hutt Valley and                     (incl. GST)                     Early                                                 $
NZ Tennis (to whom we are affiliated).                                                                       Payment

 Senior (Adult Full Member)                                                        $220                        $200

 Couple                                                                            $440                        $380

 Junior A (Primary/Intermediate)                                                   $100                           -

 Junior B (Secondary School)                                                       $120                           -

 Mid-Week  Tertiary (21 & Under)                                                  $160                           -

 Family (Living at same address)
(Use only if fees are greater than $500)                                            $500                           -

 Playing Parent (Play with child only)                                              $50                           -

 Senior Interclub Fee                                                               $80                           -

 Junior Interclub Fee                                                               $30                           -
                                                                                                                               Total Due             $

If Association levies are paid through another club, please name club: _____________________

Please attach payment to this form                                        $

Alternatively, you may pay by Internet Banking directly to: Upper Hutt Bowling and Tennis Club Inc (Tennis
Section) account: ANZ 010771 0018794 03                         Direct credit date: ____________________

If you choose to pay by Direct Credit, please ensure you quote your full name on the payee field as
reference. THIS SUBSCRIPTION IS NON-REFUNDABLE.

Introduced By_______________________ Name (please print) ______________________
(Introducing member must sign for discount to apply)
Signed ____________________________ Date _______________________
Privacy: As an Incorporated Society, we are legally required to collect this information. You have rights under the Privacy Act 1993 to access to and correction of this information.
Personal details such as members’ names, addresses and telephone numbers will be included on membership lists which may be displayed at the clubhouse and /or circulated to
other members. Although not currently required, we may in future have to disclose the names of members to either Hutt Valley Tennis and/or NZ Tennis (to whom we are affiliated).
By signing this application you agree to the above.



Amount Paid: $___________                                  Date Received: ____________                                  Receipt No. ____________________

				
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