SUSSEX COUNTY LTCADULT MEMBERSHIP RENEWAL FORM2021 – 2022 Step 1 of 3 33% Name* First Surname Email Address* Please complete any of the following if changed or not previously provided, otherwise proceed to the next page.Phone NumberPhone Number (Optional)Address Address Line 1 Address Line 2 City County Post Code Family Membership DetailsNames, Junior Dates of Birth.BTM NumberDisplay Contact DetailsDisplay your contact details on the club website and clubhouse noticeboard.YesNoWebsite RegistrationAccess to the club website members' area (court booking system, photo gallery, member contacts, news, events, tournaments, and more).Yes Payment Method*Bank TransferCardDirect Debit - AnnualDirect Debit - MonthlyChequeBank transfer to Sussex County LTC - 30-91-91 - 30880360, reference: member`s name.Please pay online when this form is submitted.Cheque payable to Sussex County LTC with member`s name on the back of the cheque.Please setup the direct debit mandate when this form is submitted, if not already done so. Three consecutive monthly instalments will be taken from your bank account at the middle of each month, starting on 15/03/21.Please setup the direct debit mandate when this form is submitted, if not already done so. One payment will shortly be taken from your bank account.Credit/Debit Card* Card Details Cardholder Name Membership Category*Senior MemberFamily MembershipIntermediate MemberCountry MemberTwo adults and any number of juniors aged under 18.Aged 18 to 21 in full-time education.Resident outside Sussex.Prompt Payment DiscountPaid before 15th March 2021. Price: -£ 10.00 Prompt Payment DiscountPaid before 15th March 2021. Price: -£ 50.00 Prompt Payment DiscountPaid before 15th March 2021. Price: -£ 100.00 Prompt Payment DiscountPaid before 15th March 2021. Price: -£ 35.00 Prompt Payment DiscountPaid before 15th March 2021. Price: -£ 10.00 PP Discount AmountDonation Donate Goodwill Discount Member Referral Discount CodeAdult Member Referral DiscountApproval Required. Not country members referred. Price: -£ 20.00 Quantity: Adult Member Referral Name 1* First Surname Adult Member Referral Name 2* First Surname Adult Member Referral Name 3* First Surname Junior/Country Member Referral DiscountApproval Required. Price: -£ 5.00 Quantity: Junior/Country Member Referral Name 1* First Surname Junior/Country Member Referral Name 2* First Surname Junior/Country Member Referral Name 3* First Surname Committee Committee Member Committee Member Discount Price: £ 0.00 Adult Member Referral Discount AmountJunior/Country Member Referral Discount AmountMonthly FeeAnnual FeeAnnual Fee £ 0.00 Signature*Date* Date Format: DD slash MM slash YYYY * I wish to renew my membership and I consent to scltc.co.uk collecting and storing my data from this form. Card and bank account data are not stored. EmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.
