Family Application Form 2015 - North Oxford Lawn Tennis Club

 Application Date : ____/_____/___________ Further information
is available on our website: noltc.co.uk Members registered as British
Tennis Members who have "Opted In" to the Wimbledon Ballot on the British Tennis
website will be eligible for our Club’s Wimbledon Ticket Ballot.
First adult Second adult First name: First name: Surname: Surname: Date of birth: Date of birth: Address: Home Phone: Mobile phone: Postcode: Home phone: Mobile phone: Email: (BLOCK CAPITALS PLEASE) (used to communicate club news, events tournaments, and to book courts) Emergency contact name and phone number for children: Email: (BLOCK CAPITALS PLEASE) Membership Category Family Membership (includes both £ 590 parents & all children 18 & under) You may pay by direct debit by filling in the direct debit form. If you paid by debit last year, you don’t need to fill in the form again. Total Paid : £ ________________ You may also pay by direct payment into bank sort code 40-­‐35-­‐34 account no. 62414686 quoting surname and initial as reference or by cheque payable to NOLTC writing your address on the back, and returning it with this form. Further information is available on our website: noltc.co.uk CHILD’S NAME + DOB CHILD’S NAME + DOB Your subscriptions include your contribution to the L.T.A.
CHILD’S NAME + DOB All the above details will remain confidential within NOLTC.
CHILD’S NAME + DOB This guarantee should be detached and retained by the Payer. The Direct Debit Guarantee • This Guarantee is offered by all Banks and Building Societies that take part in the Direct Debit Scheme. The efficiency and security of the Scheme is monitored and protected by your own Bank or Building Society. • If the amounts to be paid or the payment dates change PSL re North Oxford Lawn Tennis Club will notify you 5 working days in advance of your account being debited or as otherwise agreed. • If an error is made by PSL re North Oxford Lawn Tennis Club or your Bank or Building Society, you are guaranteed a full and immediate refund from your branch of the amount paid. • You can cancel a Direct Debit at any time by writing to your Bank or Building Society. Please also send a copy of your letter to us. st
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If you fill in this form then we will collect your membership fee via direct debit, over 10 instalments, on 1 May, 1 June, etc st though till 1 February eg a Family joining this year would have their £590 fee split over 10 payments of £59. If you would st
like to pay via direct debit, then we must receive this form back by 1 April. INSTRUCTION TO YOUR BANK OR BUILDING SOCIETY TO PAY BY DIRECT DEBIT Service User Number (SUN): Please fill in the whole form including official use box using a 2 5 0 0 2 0 ball point pen and send it to: North Oxford Lawn Tennis Club FOR OFFICIAL USE ONLY Banbury Road North Sports Ground This is not part of the instruction to your Bank or Building Oxford Society. OX2 8EQ Important – Please complete these details: Name(s) of Account Holder(s): Account Holder(s) Name & Address: Name: Address: Bank/Building Society account number: Postcode: Email Address: Branch Sort Code: Instruction to your Bank or Building Society Please pay PSL re North Oxford Lawn Tennis Club Direct Debits Name and full postal address of your Bank or Building: from the account detailed in this Instruction subject to the To: The Manager Bank/Building Society: safeguards assured by the Direct Debit Guarantee. I understand that this Instruction may remain with PSL re North Oxford Lawn Tennis Club and, if so, details will be passed electronically to my Bank/Building Society. Address: Signature(s): Postcode: Date: Reference Number: Banks and Building Societies may not accept Direct Debit Instructions from some types of account