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. Excludes coaching package.

    Membership Category:

    Adult: £42Junior: £21Coaching Package: £245

    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.