SUSSEX COUNTY LTC ADULT APPLICATION FORM 2018 – 2019 Age 18 and Over Step 1 of 4 25% Name(s)*First NameLast Name Family membership: Please provide the names of spouses/partners and children under the age of 18. Couple membership: Please provide both names.Address* Address Line 1 Address Line 2 City County Post Code Phone Number*Phone Number (optional)Email Address* British Tennis Membership NumberPlease note that this information may be stored on a computer database and a website run on a server outside the EU and UK. Membership Category*Senior MemberCouple (living at the same address)Family Membership (2 adults and any number of juniors 18 and under)Intermediate Membership (age 18 to 21)Country Membership (resident outside Sussex)Total £ 0.00 Payment Method*ChequeBank TransferCardCheques should be made payable to Sussex County LTC.For bank transfers please contact the club.For card payments please pay online at the end of the form. Website Registration*Access to website members' area (court booking system, photo gallery, member contacts, news, events, tournaments, and more).YesNoYour name/email address and other optional data are stored on the club website.Display Name and Contact Details*Display your name and contact details on the club website and clubhouse noticeboard.YesNoYour name and contact details are stored on the club website.British Tennis Membership*Permission for the club to sign you up to free British Tennis Membership Lite.YesNoPlease confirm at the time a photograph is taken, if you do not wish this to be used on the club website. Card Total £ 0.00 Credit/Debit Card* MasterCardVisa Card Number Month010203040506070809101112 Year20182019202020212022202320242025202620272028202920302031203220332034203520362037 Expiration Date Security Code Cardholder Name Signature*Date* * I agree to abide by the Rules and Bye Laws of the Club which are posted on the Club noticeboard and website, and I consent to scltc.co.uk collecting and storing my data from this form. Card data is not stored. PhoneThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.