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'.