Cricket Club Member Registration Form

Collects contact details, health information, and membership type from those wishing to join the cricket club.

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Name*

First Name

Last Name

Address*

Street Address

City

State / Province

ZIP / Postal Code

Email*

Date of Birth*

Phone Number

Have you confirmed with your GP, if you are in the High Risk Category?*

Yes No

Additional Comments

Do you have any medical conditions that the club should be aware of ?*

Yes No

If so, please provide details

Type of Membership*

Adult Membership Junior Membership Family Membership Social Membership

Spouse/Partner Name

First Name

Last Name

Payment*

Cash Credit Card Bank Transfer Cheque

Signature

Sign here

Date Signed

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