Hillingdon Table Tennis Club Premier Club Fees: Annual Membership League Player £22 Associate member £20 Associate couple £30 Junior £17 Junior sibling £8.50 Session Senior Member £5 Under 16 Member £4 Non member £6 Junior is born on or after 1st January 2001 (for season 2018/19) Affiliated to: Send forms and payment to Club Secretary cheques made out to H.T.T.C. Nationality: .......................................................................................................... Do you have British Citizenship? YES/NO Are you a member of another National TT Association? YES/NO Declaration I have read and agreed to abide by the Club rules and Code of Conduct. I agree to this information being kept on the ETTA and Club database. Signed........................................................................Date................................ For under 16s this form should also be signed by a parent/guardian/carer. I understand that my son/daughter/child in my care will be required to abide By the club rules and codes of conduct, and that in the event of an incident All reasonable steps will be taken to use the emergency contacts and that The Club will deal with the incident appropriately. School ................................................................................................................ Signed........................................................................Date................................. For Official use: Cash/Cheque Date Received...................Signed..................... Supported by: The Jack Petchey Foundation Hillingdon Community Trust Club Venue Address: Oak Wood School Sutton Court Road, Hillingdon, UB10 9HT Club Secretary: Susan Merican Tel; 01895 251725 152, Harefield Road, Uxbridge, Middx, UB8 1PP Membership Application Form

TTE No: ____________ MEMBERSHIP DETAILS Name: Address: Post Code: Gender: Date of Birth: Contact Details Home: Mobile: Email: Medical Information: Nationality: Do you have British Citizenship? YES/NO Are you a member of another National TT Association? YES/NO HTTC is a Table Tennis England Premier Club. As a Premier Club we are required to ensure that all members are registered as a member of Table Tennis England, either as an associated member, player or Licenced player member. Where already registered with Table Tennis England please enter your number below. Surname First Name Title: Occupation Address: Gender: Work Tel. Mobile No. E-Mail: Date of Birth NB. Junior - born after 31st December 1995 Cadets - born after 31st December 1998 TTE No: ____________ For Table Tennis England membership please tick which of the following ethnic groups do you most identify? Prefer not to say Asian(Bangladeshi) Mixed(Other) White(British) Asian(Other Black(British) White(Irish) Chinese Black(Caribbean) White(Other) Mixed(White & Black) Black(African) Asian(Indian) Mixed(White & Asian Black(Other) Asian(Pakistani) Other Emergency Contact numbers: Parent/Guardian/carer 1: ........................................ Parent/Guardian/Carer2: ......................................... Other: ....................................................................... Permission granted to photo or film for presentations, competition and coaching relating to HTTC only. Parent/Guardian/carer to indicate and sign: YES/NO Signature _________________________ I am interested in the following: Playing Local League ___ Hillingdon Junior League ___ Playing Nat. Cadet League ___ Playing Nat. Junior League ___ Coaching ___ Club Committee ___ Club competition Org ___ Umpiring ___ Provide transportation ___ Other:-