Membership

Section 1: Contact Information

Title:

Mr Mrs Miss Ms Dr

Address:

Date of Birth:

Can we email you club news:

YES NO

Section 2: Medical Information

Medical Conditions:

Section 3: Disability

The Disability Discrimination Act 1995 defines a disabled person as anyone with 'a physical or mental impairment, which has a substantial long-term adverse effect on his or her ability to carry out normal day-to-day activities'.

Do you consider yourself to have a disability?

YES NO

If yes, what is the nature of your disability?

None Visual Impairment Physical Disability Learning Disability Hearing Impairment Multiple Disability Other

Other important medical information:

Section 4: Ethnicity (Optional)

In order to help the club monitor its membership please select your ethnic group/origin.

Section 5: Membership Types and Fees

Please select membership type.

Basic Membership: Adult – £50 annual Basic Membership: Junior – £25 annual Family Membership – Family at one address – £50 plus £10 per additional member Coach Membership – £50 annual

Section 6: Members Sign Off

I agree to abide by the Rules and the Code of Conduct of The Kenfig Club, showing respect and consideration for other people and the Club's property.

Signed: Date:

Become a member