Coalpit Heath CC Member Registration Form

Member Registration Form

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.

Name *
Membership type *
Please select the type of membership you are applying for*Adult playing member Gold £220.00 no match subs*Adult playing member Silver £180.00 + £5 match subs*Adult playing member Bronze £140.00 + £10 match subs004 - Adult country - £30.00 - £5.00 match subs (Must live more that 50 miles from club)Ladies playing member £25.00*Adult Student £85.00
Mobile telephone number
Your email address *(A confirmation email will be sent to this address)
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