SUSSEX COUNTY LTCJUNIOR MEMBERSHIP APPLICATION FORM2019 – 2020 Age Under 18 Step 1 of 5 20% Membership Category*Junior Member aged 10 and underJunior Member aged 11 to 17Membership 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 Lite.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 Membership Fee £ 0.00 Payment Method*Bank TransferCardChequePlease contact the club.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* MasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 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.