Membership Form - Kenilworth Tennis,Squash and Croquet Club

Name*

Gender*

Email*

Home Phone

Mobile Phone

Date of Birth

Date of Birth required for age category membership, but helpful if it can be included for all categories

Membership Category and monthly cost*

Add another member?*

Yes
No

Name of 2nd member

Gender

Email

Home Phone

Mobile Phone

Date of Birth

Membership Category and monthly cost*

Add a third member?*

Yes
No

Name of 3rd member

Gender

Email

Home Phone

Mobile Phone

Date of Birth

Membership Category and monthly cost*

Add a fourth member?*

Yes
No

Name of 4th member

Gender

Email

Home Phone

Mobile Phone

Date of Birth

Membership Category and monthly cost*

Add a fifth member?*

Yes
No

Name of 5th member*

Gender*

Email

Home Phone

Mobile Phone

Date of Birth

Membership Category and monthly cost*

Add a sixth member?*

Yes
No

Name of 6th member*

Email

Home Phone

Mobile Phone

Date of Birth

Membership Category and monthly cost*

How did you hear about us?*

If referral, please provide member's name below