Personal Details


Title: MrMrsMissMsDr
First Name:
Surname:
Address:
Postcode:
Telephone:
Mobile:
Email:
Date of Birth:

British Tennis Membership No.:

I would consdier myself to be: BeginnerIntermediateAdvanced



Emergency Contact Details

Emergency Contact Details:
First Name:
Surname:
Telephone:
Mobile:
Email:


Medical Conditions & Allergies

It would be helpful if you could advise us of any special care needs, medical conditions, dietary requirements or allergies.

Medical Conditions & Allergies

Membership Category

Subscription rates below are for a full year from 1st March to the end of February. To calculate the amount payable, divide by 12 and multiply by the number of complete months remaining up to and including next February. (Ages apply at the previous 1st March)

Membership Category: Adult: £40Junior: £20

Payment Method

Payment Method:
Cheque: Cheques Made payable to: LLTC Ltd.

Direct Debit: Please contact office for Direct Debit Mandate Form

Online Payment: Online Payment details will be provided via email.

Parent Name:
Date:



By submitting this form you confirm application to become a member of the Leicestershire Tennis and Sqaush Club.