I, the undersigned / Je, soussigné:
Name, First name / Nom, Prénom…………………………… ………………………………………….. ……………………………………….
Address in France/ Address in France …………………………………….. ………………………………………….. ……………………………..
………………………………………….. ………………………………………….. ………………………………………….. …………………………..
Such:………………………………………… …………………………………. E-mail:…… ………………………………………….. ………………….
Address overseas/ Address abroad …………………………………….. ………………………………………….. ……………………………..
…………… ………………………………………….. ………………………………………….. ………………………………………….. …………….
Such:………………………………………… …………………………………. E-mail:…… ………………………………………….. ………………….
Nationality/Nationalité………………………………………….. …………………………….
Players only / only players
Date of birth / Born on …………………………………….. ……………………. Place of birth / at……………….. ……………………………………..
Wish to join the club as: / request to join the association as: (please tick/cochez)
Adult Player / Major Player 65 euros*
Player U18 / Minor Player (parental authorization also required) 10 euros*
Member / Support Member 20 euros
Sponsor / Benefactor min. 20 euros
Membership Fees / Contribution
Adult Players / Major Players (License and Insurance Included) 65 euros*
U18 Players / Minor Players (Licence and Insurance Included) 10 euros*
Members / Supporting Members 20 euros
Sponsors / Benefactors minimum 20 euros
*If a playing member I confirm that I have the French medical certificate confirming my fitness to play
Enclosed please find a check for / Please find attached a check for …………..euros made out to Entrecasteaux Cricket Club
To be sent to Ann Mitchem ECC Treasurer / to be sent to Ann Mitchem:
Date………………………….. Signature……………… ……………………………………..