Coalpit Heath Cricket Club
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Instructions
All fields marked with an asterisk * are mandatory. If you are an existing member only complete details that have changed since you last registered If you are a new player please complete all fields. Once complete click "Submit". A confirmation email will be sent to your email address.
Your details
Your name
*
Membership type
*
Please select the type of membership you are applying for
Adult playing member
Student playing member (in full time education under the age of 24 on 1st September this year)
Home telephone number
Mobile telephone number
Your email address
*
(A confirmation email will be sent to this address)
Address
Street Address
Apt, Suite, Bldg. (optional)
City
State / Province / Region
Postal / Zip Code
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo (Brazzaville)
Congo
Costa Rica
Cote d\'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor Timur)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
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Lithuania
Luxembourg
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Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
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Mauritius
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Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
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Niger
Nigeria
Norway
Oman
Pakistan
Palestinian Territory
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
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Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent
Samoa
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Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
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Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Western Sahara
Western Samoa
Yemen
Zambia
Zimbabwe
Country
Date of birth (NB dates are in US format - mm/dd/yyyy)
Medical conditions
Please provide details of any pre-existing medical conditions, alergies etc
Occupation, skills and expertise
Do you have specific skills or expertise that might be of use to the cricket club? For example, are you a builder or a plumber?
Communication preferences
*
We will use contact details provided to contact you about cricket activities. We may also contact you by email or telephone about other cricket club news and events. We will never knowingly pass your details onto other parties. Please choose your communication preference
Please contact me about cricket playing and other club news and events
Please only contact me about playing cricket
Current educatonal institute
If you are a student member please provide the name of the educational establishment you are attending
Gift Aid declaration
Declaration
I confirm I have paid or will pay an amount of Income Tax and/or Capital Gains Tax for each tax year (6 April to 5 April) that is at least equal to the amount of tax that all the charities or Community Amateur Sports Clubs (CASCs) that I donate to will reclaim on my gifts for that tax year. I understand that other taxes such as VAT and Council Tax do not qualify. I understand Coalpit Heath Cricket Club will reclaim 28p of tax on every £1 that I donated up to 5 April 2008 and will reclaim 25p of tax on every £1 that I donated on or after 6 April 2008.
Gift Aid it?
*
Do you want the cricket club to claim Gift Aid on donations made?
No, I do not want the cricket club to claim Gift Aid on donations made
Yes, I want the cricket club to claim Gift Aid on all donations made
Important
Please notify the charity or CASC if you: - Want to cancel this declaration - Change your name or home address - No longer pay sufficient tax on your income and/or capital gains. If you pay Income Tax at the higher or additional rate and want to receive the additional tax relief due to you, you must include all your Gift Aid donations on your Self Assessment tax return or ask HM Revenue and Customs to adjust your tax code.
Your Name
*
Today's date
*
Verification
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*
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