SUSSEX COUNTY LTCJUNIOR MEMBERSHIP APPLICATION FORM2021 – 2022 Age Under 18 Step 1 of 5 20% Membership Fee Type*Pro-rataOfferSPECIAL OFFER: MEMBERSHIP UNTIL 28TH FEBRUARY 2022. OFFER ENDS ON 6TH DECEMBER 2020.WINTER OFFER: MEMBERSHIP UNTIL 28TH FEBRUARY 2021.Membership Category*Membership until 28th February 2022.Junior Member aged 10 and underJunior Member aged 11 to 17Membership Category*Junior Member aged 10 and underJunior Member aged 11 to 17Club Opening Discount10% Discount. Price: £ 0.00 Spring Discount10% Discount. Price: £ 0.00 Membership Fee £ 0.00 Name* First Name Surname Date of Birth* DD MM YYYY Parent Name* First Name Surname Email Address* Phone Number*Phone Number (optional)Address* Address Line 1 Address Line 2 City County Post Code British Tennis Membership Number Special RequirementsPlease describe any special care needs, dietary requirements, allergies or medical conditions.British Tennis Membership*Permission for the club to sign you up to free British Tennis Membership.YesNoPlease note that this information may be stored on a computer database and a website run on a server outside the EU and UK.Please advise at the time a photograph is taken if you do not wish the photograph to be used on the club website. Junior Member's Signature*Date* Date Format: DD slash MM slash YYYY Parent / Guardian Declaration (essential if the applicant is under 16 years of age)* I agree to my son/daughter taking part in the general activities of the club. He/she has agreed to follow the junior rules of the club and I agree to accept the code of conduct for parents. To my knowledge, he/she has no special care needs, dietary requirements allergies or medical conditions that could affect his/her safety at the club; other than those declared on this form. I understand that in the event of any injury, illness or other medical need all reasonable steps will be taken to contact me and deal with the situation appropriately. I understand that I must inform the club of any changes to the information provided on this form. Parent/Guardian Signature*Date* Date Format: DD slash MM slash YYYY Promotional Discount CodePromotional Discount Price: £ 0.00 20% Discount.Membership Fee £ 0.00 Payment Method*Bank TransferCardBank transfer to Sussex County LTC - 30-91-91 - 30880360, reference: member`s name.Please pay when this form is submitted.Cheque payable to Sussex County LTC with member`s name on the back of the cheque.Credit/Debit Card* Card Details Cardholder Name Credit/Debit Card* MasterCardVisa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name * I consent to scltc.co.uk collecting and storing my data from this form. Card data is not stored. How did you hear about us?NameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.