2_senior_registration by islaamalsalhi

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									                             Whitby Tennis Club Inc
                        Application for Membership 2011/12


Name:


Address


Day phone:
Evening phone:
Mobile phone:
Email address:
Email is the Club’s preferred method of communication so please advise if this is not
a suitable method for communicating with you.


Type of Membership
Tues/Wed night league*only                       [ ]     $160 or $150 if paid by 30/10/11
Weekend interclub only                           [ ]     $230 or $220 if paid by 30/10/11
Tues/Wed league and Interclub                   [ ]      $250 or $240 if paid by 30/10/11
Social                                          ( )          $90 or $80 if paid by 30/10/11

*Available Tuesday evening [ ] and/or Wednesday evening [ ]


Please complete this form and send with your cheque for the appropriate fee to:
Whitby Tennis Club Inc
20 Latitude Close
Whitby
Alternatively, you may deposit the appropriate fee to Whitby Tennis
Club’s account 03 0547 0204402 00 at Westpac, Porirua and email
this form to whitbytennis@xtra.co.nz . You must ensure your name
appears as the reference for the deposit.

Privacy act: The undersigned consent to the collection of the above details by Whitby Tennis
Club for the purpose of establishing membership records, distributing tennis publications, and
for it to retain, use and disclose these to regional and national associated tennis bodies,
being Tennis Central Region and Tennis New Zealand, for the same purposes. I acknowledge
my right to access and if necessary correct this information. This can be with the knowledge
that this information will only be collected and used for tennis specific purposes and will not
be provided to any organization apart from the tennis bodies referred to in this paragraph.

								
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