Please complete all sections that apply

Main applicant details* This field is required.

Title

First Name

Surname

Gender

Occupation

Contact Details* This field is required.

Address

Town/City

County

Postcode

Email Address

Home phone

Mobile phone

Date of Birth* This field is required.

Do you have any medical conditions that could affect your ability to participate in your sport or activity?* This field is required.

Yes (Please enter details)

Parent or Guardian Name(Where applicant is aged under 18 years of age)

First Name

Last Name

Mobile

How did you hear about us?

A friend or colleague

Online search (Google, Bing, Yahoo)

Open day

Local magazine or newspaper

Coach

Are you being introduced by a West Worthing Club Member?

Yes (Please confirm their name)

Please indicate main sports or activities:* This field is required.(Please select all that apply)

Tennis

Squash

Racketball

Table Tennis

Snooker

Croquet

Petanque

Running

Bridge

Social Membership

Category of membership required* This field is required.(Please refer to the Membership Price List for details of membership categories including subscription fees)

Payment is collected by Annual or Monthly Direct Debit:* This field is required.(Please state your preference)

Pay by monthly DD

Pay by Annual DD

Please upload a ‘head and shoulders’ photo of the main applicant.(Your photo will only be used for the purposes of identifying you when using your membership card)

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

Do you wish to add any family members?* This field is required.(Family members must live at the same address as you)

Yes

Partner details

First Name & Surname

Gender

Date of Birth

Main sport or activity

Membership category

Email address

Mobile phone

Medical conditions

Please upload a ‘head and shoulders’ photo of your partner.(Their photo will only be used for the purposes of identifying them when using their membership card)

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

Child under the age of 18 years

First Name & Surname

Date of Birth

Gender

Main sport or activity

Membership category

Medical conditions

Please upload a ‘head and shoulders’ photo of your child.(Their photo will only be used for the purposes of identifying them when using their membership card)

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

Child under the age of 18 years(Children must live at the same address as you)

First Name & Surname

Date of Birth

Gender

Main sport or activity

Membership category

Medical conditions

Please upload a ‘head and shoulders’ photo of your child.(Their photo will only be used for the purposes of identifying them when using their membership card)

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

Child under the age of 18 years(Children must live at the same address as you)

First Name & Surname

Date of Birth

Gender

Main sport or activity

Membership category

Medical conditions

Please upload a ‘head and shoulders’ photo of your child.(Their photo will only be used for the purposes of identifying them when using their membership card)

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

Cancellation Policy

Annual memberships run for a period of 12 months and are non-cancellable.

Monthly memberships may be cancelled by giving 3 calendar months' clear notice to the Club in writing or by email.

Cancellation Policy Confirmation* This field is required.

I have read and understood the Cancellation Policy

Data Protection* This field is required.

I understand that the the information supplied in this application form may be stored in paper format and/or electronically. Your information will be used by the Club to administer your membership and provide you with details of Club information, news, events or offers.

Photo Policy

I understand that occasionally, photos and videos from club competitions and practices will be used in promotional material for the club. I agree to allow my image or my child's image to be used for this purpose and that I will not be compensated. I also understand that once a promotional item has been produced, it is not possible to remove my image or my child's image from the production.

Signature of Member or Parent / Guardian* This field is required.

Clear

Date

Please verify that you are human* This field is required.

Please complete all sections that apply