Additional Charges/Services Membership 2017/2018 Invoice GST No.55-478-554 CLUB USE ONLY: Date Paid Payment # Receipt # Key # Database Member Details (Including Family/Couple): Family Name First Name Gender Interclub? DOB 1. M/F Y/N 2. 3. 4. 5. Email: Address: Work: Home: Mobile: Memberships: www.cptc.co.nz Type Fees (Circle) Additional Charges/Services Fee (Circle) Senior 18 and over at 1/1/18 $395 Senior Interclub (excludes ball costs) $50 Couple Partner at same address $750 Key Card (all new members except juniors) $30 Junior under 18 at 1/1/18 $245 New Junior Joining Fee $40 Junior plays Senior $280 Junior Interclub (coaching & ball costs) pre-Xmas Junior Interclub (coaching & ball costs) post-xmas $110 Student Full time tertiary under 25 with current semester invoice Uniform Boy Uniform Girl $45 Midweek Playing rights 9am - 3pm Mon - Fri Midweek Interclub (excludes ball costs) Family Senior couple + children under 18 at 1/1/16 living at home $995 Total Fees $ Total Extras Grand Total (All Charges GST inclusive) Payment Options: Cash Cheque - post with this form to: Campbell Park Tennis Club, PO Box 17-003, Greenlane, Auckland 1546 Direct debit: ASB 12-3030-0496303-00 put surname in the reference & return this form to the club (cptc@xtra.co.nz) As a Member of Campbell Park Tennis Club: Phone: 520 2191 Email: cptc@xtra.co.nz I agree to abide by Club rules I agree to my name/telephone numbers being available to other members Signed: