© Copyright Herne Bay United 2011

Follow us on Facebook

Membership Application Form

    Personal Details

    Name MaleFemale
    DOB Parental consent requiredNoYes
    Email
    Address
    Postcode

    Is child provided with special drugs or use of medical equipment for medical reasons. If YES, please detail below



    Is child to the best of your knowledge allergic to any medication? If YES, please detail below

    TELEPHONE
    Home
    Mobile

    SECTION
    Social / Friday NightArtistic Roller DanceRoller Hockey

    Membership no.

    Medical conditions that may affect child's sport participation

    NoYes

    If YES, please give brief details

    Additional Members

    SECOND MEMBER

    Name MaleFemale
    DOB Parental consent requiredNoYes
    Membership no.

    THIRD MEMBER

    Name MaleFemale
    DOB Parental consent requiredNoYes
    Membership no.

    FOURTH MEMBER

    Name MaleFemale
    DOB Parental consent requiredNoYes
    Membership no.

    FIFTH MEMBER

    Name MaleFemale
    DOB Parental consent requiredNoYes
    Membership no.

    SIXTH MEMBER

    Name MaleFemale
    DOB Parental consent requiredNoYes
    Membership no.

    Emergency Contact Number

    In case of emergency, please list any additional Contacts or Telephone Numbers below:

    Contact
    Phone
    Contact
    Phone

    Payments

    I apply for membership of the club as set out in this Membership Application Form and will arrange payment for the amount shown below as the subscription:

    Junior (Under 18 Years) £20
    Senior (18 Years & over) £25
    Senior £35
    Parent (Guardian) plus 1 £28
    Life Member £28

    CLUB NIGHT - Weekly cost after membership paid

    7pm to 8pm - £1
    8pm to 9pm - £1
    £2 (if have own skates)

    Skate Hire - £2.30 payable to Arena if required - £4.30 (If have to hire skates)


    I understand that if my application is not accepted, the payment of the subscription will be returned.
    I have received and read the Club Constitution and agree to abide by the Constitution and the Bye-Laws.

    Signed: Date: