Membership form

Entrecasteaux Cricket Club 

Membership Form 2023

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:

45 Traverse Marcel Pagnol, 1303 D’or et  D’ocre 83300 Draguignan. FRANCE

                               

Date………………………….. Signature……………… ……………………………………..