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- First name:........................................
- Surname:...........................................
- Please circle: male/female/other........
- Date of birth:.............................
- Email address:.....................................
- Phone number:......................................
- Emergency contact name:............................
- Emergency contact phone:...........................
Optional
- Do you have a disability?
- Do you have a culturally or linguistically diverse background?
Circle membership requested:
- Senior Competitive, $185 p.a.
- Junior Competitive, $110 p.a.
- University Competitive, $110 p.a.
- Social, $40 p.a.
"Competitive" membership is required for participation in TTSA-sanctioned events, including TTSA Winter Pennant, NEHTTA competitions, and TTSA tournaments.
The four membership categories all provide player accident insurance cover.
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Payment type (circle):
- Cash
- Square/EFTPOS---please attach receipt to this form, or ask session leader to certify payment on this form.
- EFT to HEATTC bank account: BSB 105-152; Account number 065057840
Please initial acceptance of each of the following:
- I understand that player accident cover is not activated until membership and payment are confirmed.
- In the event of of an injury or medical emergency where I am unable to communicate, I authorise the club, its officials or members to seek and obtain medical assistance on my behalf, including calling an ambulance. I acknowledge that I am responsible for any costs associated with such medical treatment.
- I have received a copy of the "Code of Conduct" and undertake to read and abide byits requirements.
Signatures
- Signed:..................................
Date:....................................
- Session Leader:..........................
Signed:..................................
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