Membership

Membership Application

# check this box if you do NOT wish this information to be available to other SSRC members.

^ for eligibility to competitions / teams / discounts.

indicates that this information is mandatory.

Name

Address

Postcode

Date of Birth

(ddmmyy) ^

EMail Address

Home Phone

Mobile Phone

Work Phone

Occupation

Student Number

Number of Children

(proof may be required)

Second Adult

Name

EMail Address

Date of Birth

(ddmmyy) ^

Mobile Phone

Work Phone

Occupation

Children

Name

Date of Birth

(ddmmyy)

Mobile Phone

EMail Address

Name

Date of Birth

(ddmmyy)

Mobile Phone

EMail Address

Court pre-payment

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	I have read and agree to abide by the SSRC members' rules.	Read SSRC members' rules ...
	I agree that my details may be passed to 'England Squash'.