ࡱ> =G<t5@ 0ibjbj22 rfXXH TTTh<hGt'6]q $RO"tTL"'LLe:::L4lT:L::2(,T2h @,20G2""2hh"T2}vT:GD}}}hh$ *hhMembership Application/Renewal Form 2011-2012 Name: DOB (U18):Address: Postcode:Tel (1): Tel (2):E-mail:Occasional use of my image for website/newsletters/press YES/NOLTA age profile: please tick your age on 1st Jan 2011Under 1010-1718-7575+Please tick as appropriate Membership Category (age on 1st Jan 2011)Cost TickSenior67.00Intermediate (16+ in full time education)38.55Junior (14-15)30.00Raw (10-13)19.50Social7.00Winter (October 1st 2011 March 31st 2012)22.00Mini (under 10)12.00N.B. Family membership = 1st 2 members full price, half price thereafter I would like to join/renew membership of Mold Lawn Tennis Club for the 2008 season (1/4/09 31/3/10). I enclose payment for the amount of __________ (cheques payable to Mold Tennis Club) Please send to: Trevor Webb (Membership Secretary) Glenwood Cefn Bychyn Road Pantymwyn CH7 5EL Signed: _____________________ Signed: ______________________ (player) (parent/guardian U18s) *Existing members, to ensure registration for the new season please return forms and payment by 1st May 2011. For more information please visit our website at  HYPERLINK "http://www.moldtennis.org.uk" www.moldtennis.org.uk Data Protection Act 1984: The information supplied on this form will be stored on a computer for Club use only, and will not be passed on to any third party.  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