Annual Memberships Croquet

Name*
Gender*
Email*
Home Phone
Mobile Phone
Date of Birth
DD slash MM slash YYYY

Date of Birth required for age category membership, but helpful if it can be included for all categories
Membership Cost
Start Date
DD slash MM slash YYYY

Date membership will start.
Add another member?*
- Yes
- No
Name of 2nd member
Gender
Email
Home Phone
Mobile Phone
Date of Birth
DD slash MM slash YYYY
Membership Cost
Start Date
DD slash MM slash YYYY
Add a third member?*
- Yes
- No
Name of 3rd member
Gender
Email
Home Phone
Mobile Phone
Date of Birth
DD slash MM slash YYYY
Membership Cost
Start Date
DD slash MM slash YYYY
Add a fourth member?*
- Yes
- No
Name of 4th member
Gender
Email
Home Phone
Mobile Phone
Date of Birth
DD slash MM slash YYYY
Membership Cost
Start Date
DD slash MM slash YYYY
Add a fifth member?*
- Yes
- No
Name of 5th member*
Gender*
Email
Home Phone
Mobile Phone
Date of Birth
DD slash MM slash YYYY
Membership Category and monthly cost*
Add a sixth member?*
- Yes
- No
Name of 6th member*
Email
Home Phone
Mobile Phone
Date of Birth
DD slash MM slash YYYY
Membership Category and monthly cost*
Payment method*
- Direct bank transfer
- Credit/debit card via Paypal
Please select payment method
Total amount paid

Kenilworth Tennis, Squash & Croquet Club
Crackley Lane
KENILWORTH
Warwickshire
CV8 2JS
email: info@ktscc.co.uk

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