GSRA Junior Membership Application Form 2017/18

GSRA Junior Membership Application Form 2017/18 Details: Name: ______Date of Birth: ____/____/_____

Address: ______

______

Parish: ______

Post Code: ______

Telephone: Parents: Players Home: ______Alternate: ______

Mobile: ______Mobile: ______

Players E-mail Address (print clearly): ______

Parents E-mail Address (print clearly): ______

Any Relevant Medical conditions? ______

GSRA may take photos / videos for media publication and as a coaching aid throughout the season. Please tick here if you DO NOT wish for your child to be included in the use of photos / videos.

Participation (please tick): Monday Club: Tuesday Club: Friday Club: Bourse Junior League:

Membership Required: Junior GSRA are affiliated to England Squash, as part of your Junior (18 and under or in full time education) GSRA membership we will pay your England Squash Membership £25.00 membership, if you do not want us to do this tick here. Note: Memberships paid before Monday 18th September, will receive £5 discount.

I enclose (amount) £ _____ Please return this form by post or email to: Cheque (payable to G.S.R.A) Membership Secretary Cash GSRA Or pay direct to: The Coach House Bank: HSBC PLC Beau Sejour Centre Branch: High Street, St Peter Port, Guernsey Amherst Sort Code: 40-22-25 St Peter Port Account number: 21890204 GY1 2DL Account Name: Guernsey Squash Rackets Association [email protected]

Parent’s Signature: ______Print Name: ______Date: ____/____/______

Players Signature: ______Print Name: ______Date: ____/____/______

Guernsey Squash & Racketball Tel: (01481) 714567 [email protected] www.guernseysquashandracketball.co.uk The Coach House, Beau Sejour Centre, Amherst, St Peter Port, Guernsey, GY1 2DL