2021 Membership Registration Form
This form will allow you to register as a member of Worlington Cricket Club for the forthcoming season. Your application will be confirmed by the club upon payment of your membership fee.

If you are filling in this form on behalf of someone else, please enter their details instead of your own. If you are completing this form on behalf of several members then you will need to complete each membership form separately.

Please make yourself familiar with the club's policies and code of conduct which can be accessed here(insert link)

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Email *
Name *
Surname *
Date of Birth *
MM
/
DD
/
YYYY
Address *
Postcode *
Contact number *
Email address *
Membership Option *
Emergency Contact (please include name, contact no & relationship to player (parent / spouse etc) *
What can / are you willing to help with on training nights ? Must select at least 1
What can / are you willing to help with on match days ? Must select at least 1
What others skills do you have that may benefit the club or what support can you offer to help the club ?
Other skills / help you think may benefit the club please list below.
If you are interested in becoming a coach or coach helper please speak to a coach about possible courses, or if you want to enhance current level of qualification then please let a coach know.
Medical information
Do you have any existing conditions requiring medical treatment of medication the club should be aware of?
If Yes, please give details
Do you have any allergies?
If Yes, please give details
Do you have any specific dietary requirements?
If Yes, please give details
Please provide any further information you feel is necessary
Please tick to confirm the below *
Required
A copy of your responses will be emailed to the address you provided.
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