Membership Application Form

MELBOURNE CRICKET CLUB

Membership Application Form

17 Courtney Walsh Drive,

Kingston 10,

Phone: 876-926-1085

Email:melbourneccjm@gmail.com

Website: https://www.melbournecricketclub.org
Name

First NameLast Name
Date of Birth

DayMonthYear
Sex

MaleFemale
Marital Status
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail

Home Number

Area CodePhone Number
Cellular Number

Area CodePhone Number
Work Number

Area CodePhone Number
Present Employer/School
Employer/School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Occupation
Period of Service (Years/Months)
Type of Membership Sought
Are you/were you affiliated with any other Social Club
If So, Give name(s) & Office(s) held

Have you ever been refused membership to any Social Club
Please state your hobbies/interests
Name of your reference
E-mail
Phone Number

Area CodePhone Number
Address of Reference

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Applicant Signature
Signature date
Committee member proposing
Mandatory
Signature
Mandatory
Committee member seconding
Mandatory
Signature
Mandatory

Each Applicant submitted must be accompanied by the following documents:

1. One passport-sized photograph

2. 1st Years Membership Fee of J$6000.00 plus a non-refundable Application fee of J$1000.00. Membership fee due 1st July yearly.

3. Student applicants must present a letter of permission from parent/guardian and a letter of recommendation from a student teacher.
FOR OFFICE USE ONLY

Fees Paid:____________Date:___________Receipt No:____________

Issued By:_______________

Application Approved By:____________________Date:______________
Should be Empty: