PLTC Membership Form

2023 Membership Application

To apply for membership please complete all fields. The 2023 membership year runs from 01/01/2023 to 31/12/2023.
2023 Membership Rates:
For 2023, we are offering two membership options:

1. for the full 12 months

2. for 6 months (either from 1st Jan to 30th June or from 1st July to 31st Dec)

	12 Months	6 Months
Family (co-habiting partners and their children u18) 12 months = €145 6 months = €72.50
Senior 12 months = €90 6 months = €45
Unwaged 12 months = €55 6 months = €27.50
2nd Club 12 months = €70 6 months = €35
Student 12 months = €40 6 months = €20
Over 65 12 months = €70 6 months = €35
Junior 12 months = €30 6 months = €15
Pavilion 12 months = €20 6 months = €10

A fob to gain entry to the courts is an additional €20 (this is a refundable deposit)

I require a fobI do not require a fob
Example: If applying for Senior membership for 6 months and you require a fob, then the fee required will be €65 (the €20 for the fob is refunded to you upon its return if you cease membership).
Member Details:
Adult 1 Name

First Name Last Name
Mobile Phone Number
Please enter a valid phone number.
Email Address
example@example.com
Adult 2 Name

First Name Last Name
Mobile Phone Number
Please enter a valid phone number.
Email Address
example@example.com
If applying for family membership, please enter the full names and dates of birth of all children u18.
Child 1

First and Family Name Date of Birth (dd/mm/yyyy)
Child 2

First and Family Name Date of Birth (dd/mm/yyyy)
Child 3

First and Family Name Date of Birth (dd/mm/yyyy)
Child 4

First and Family Name Date of Birth (dd/mm/yyyy)
Child 5

First and Family Name Date of Birth (dd/mm/yyyy)
Please tick as appropriate

I accept the Code of Ethics and Good Practice for children in sport*I consent to have my phone number published on the member list**
* The club’s Child Protection statement is available for viewing in the clubhouse.

** All personal data is only used for club purposes and is not shared externally.
In parallel to completing this form, please pay the appropriate membership fee online via your bank to the Portumna Lawn Tennis Club account.

Note: Please ensure that you identify yourself to the club via the available field in your online banking portal (add your name).

Our BIC: BOFIIE2D
Our IBAN: IE96BOFI90394742030435
Should be Empty:

Now create your own Jotform - It's free!Create your own Jotform

2023 Membership Application

2023 Membership Rates:

Member Details: