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Maungaraki Tennis Club PO Box 30-919, Lower Hutt 5040 04 589 7565 Application for Membership 2009-10 Please enter the details below for your proposed membership, then press the 'Calculate Total' button which will check your details and come up with the price. After that you will be able to proceed to application stage.
I wish to Choose... APPLY for membership RENEW my membership	Membership type I require: Choose... Family (2 adults, 2 children) $500 Senior $224 Veteran $188 College/Tertiary (15-25) $139 Junior (11-14) $121 Grasshoppers(5-10) $111 Non-playing $30
Extras: (type in how many you want. The first 4 are for new Snr members only, 1 per person or 2 per family)
Senior Headstart Pack 1 ($35)	0 1 => New Senior Member Only 2 => New Family Members Only
Senior Headstart Pack 2 ($70)	0 1 => New Senior Member Only 2 => New Family Members Only
Senior Headstart Pack 3 ($105)	0 1 => New Senior Member Only 2 => New Family Members Only
Tennis Ball Pack (3 balls $8)	0 1 => New Senior Member Only 2 => New Family Members Only
Junior Interclub Fee ($25)	0 1 2
Entertainment Book Pre-order ($55)	0 1 2 3 4 5 6
Club Room Key ($20)	0 1

*First Names:		*Surname:
*Gender:	Male female	* Date of Birth (if under 18):	(dd/mm/yy)
Address:		Address 2:
Suburb:		Town/City:
Postcode:		Home Phone:
Mobile Phone:		Work Phone:
Email:		Occupation:
Participation - Seniors Twilight Monday 6pm      Twilight Tuesday 6pm      Twilight Wednesday 6pm      Thursday Competitive Night 6pm     Senior Interclub (Sat, Sun, Mon)     Midweek Club Morning (Tues 9.30/10am)     Midweek Interclub (Wednesday mornings)     Midweek Mixed (Friday morning fortnightly)
Participation - Juniors Grasshoppers Programme - Monday from 3.15pm     Intermediate/College - Friday from 5.30pm     Junior Interclub - Saturday mornings     Can offer parent help - Team Mgmt / Coaching

Family members included in membership
Name	Sex	DOB (if under 18)	Mobile	Member Type
Second Adult:
	? M F			Senior Veteran College/Tertiary (15-25) Junior (11-14) Grasshoppers(5-10)
Participation - Seniors Twilight Monday 6pm      Twilight Tuesday 6pm      Twilight Wednesday 6pm      Thursday Competitive Night 6pm     Senior Interclub (Sat, Sun, Mon)     Midweek Club Morning (Tues 9.30/10am)     Midweek Interclub (Wednesday mornings)     Midweek Mixed (Friday morning fortnightly)
First Junior:
	? M F			College/Tertiary (15-25) Junior (11-14) Grasshoppers(5-10)
Participation - Juniors Grasshoppers Programme - Monday from 3.15pm     Intermediate/College - Friday from 5.30pm     Junior Interclub - Saturday mornings     Can offer parent help - Team Mgmt / Coaching
Second Junior:
	? M F			College/Tertiary (15-25) Junior (11-14) Grasshoppers(5-10)
Participation - Juniors Grasshoppers Programme - Monday from 3.15pm     Intermediate/College - Friday from 5.30pm     Junior Interclub - Saturday mornings     Can offer parent help - Team Mgmt / Coaching

COMMUNICATIONS FROM MAUNGARAKI TENNIS CLUB see paragraph 7 of the Membership Declaration (below). All our correspondence and newsletters will be sent via email.Tick if you wish to: Be contacted in regards to coaching lessons Subscribe to Passing Shots - a free, weekly online newsletter from Tennis New Zealand

PRIVACY see paragraph 7 of the Membership Declaration (below) * Name, Gender and Member Type will be passed to your Regional Centre and Tennis NZ for affiliation purposes. MTC will publish team lists to other club members of the leagues they are playing in. Therefore your name, phone number and email address will be made available to the relevant teams, and may be published on our secure website. Tick if you do not wish your details to be made available on the club's secure website.

NEW MEMBERS - you can help us build a better club by answering these. Why did you decide to join Maungaraki Tennis Club? (e.g. Live nearby, Coaching, Grasshoppers, Friends belong) How did you first hear about us? Choose... Letterbox flyer Website / Internet Billboard / Signs School Newsletter Community Newsletter Hutt News Petone Herald Word of Mouth

UNDER 18 YEARS , parent, guardian, caregiver consent and EMERGENCY CONTACT I am the parent/guardian/caregiver of the applicant who is under 18 years of age. I have read and understood this application form and the applicant's Membership Declaration (below). I understand the application form and the Declaration and I consent to the applicant's application for membership on the basis set out in the form and Declaration. I also consent to my name and contact details as detailed below, being collected, held and used as the applicant's parent, guardian or caregiver in accordance with the purposes set out in paragraph 7 of the Membership Declaration or for contacting me in an emergency involving the applicant. Tick to agree:
Name:		Relationship:
Home Phone:		Work Phone:
Email:		Mobile Phone:

Total Owing: $ 0

MEMBERSHIP DECLARATION

1. Accuracy: The details set out in the Application for Membership Form are true and correct. If they change I acknowledge that I am required to notify my Club of the changes, in writing, as soon as possible after they occur.
2. Bound by Rules: I will be bound by the constitutions, regulations, policies, manuals, guidelines and reasonable directions of the Club, the Regional centre which my Club is a member of and Tennis NZ
3. Accept Risk of Tennis: I have voluntarily accepted and assumed the inherent risk of danger and injury in tennis.
4. No liability: I will not hold my Club, the Regional Centre or Tennis NZ or their respective officers responsible or any claims, losses and expenses and costs (including legal costs) which may arise from or in connection with my membership and/or participation in any activity authorised or recognised by my Club, the Regional Centre or Tennis NZ except in the case of gross negligence or a wilful act or omission on the part of my Club, the Regional Centre or Tennis NZ.
5. Indemnity: I indemnify my Club, the Regional Centre and Tennis NZ from all claims, losses and expenses (including legal costs) suffered or incurred at any time as a result of, or resulting directly or indirectly from, my failure to observe the constitutions, regulations, policies, manuals, guidelines and reasonable directions of my Club, the Regional Centre and Tennis NZ respectively.
6. Medical Declaration: I am medically and physically fit and do not suffer from any injury, disease or condition, either physical or mental, that would affect my ability to safely participate in any authorised or recognised activities of my Club, the Regional Centre or Tennis NZ. If I am unsure about this declaration, or suffer from such a condition I have either listed it on the application for membership form or I am aware that I must bring it to the attention of my Club.
7. Privacy: I agree that my Club, the Regional Centre and Tennis NZ can collect, hold, use and disclose my personal information on the Application for Membership Form (and any updated or additional personal information my Club, the Regional Centre or Tennis NZ obtains from me whilst a member including any photo or other record of my image) for the purposes of:
1. Processing my application for membership including notifying Tennis NZ of the information on the Application for Membership Form for the purposes of my Club compiling a register of members in accordance with the Incorporated Societies Act 1908 and for the purpose of the Regional Centre and Tennis NZ compiling a national database of members and participants (accessible only by my Club, the Regional Centre and Tennis NZ);
2. If I agree, putting my name and contact information on my club's membership list for use by other members of my club;
3. Publishing any of my tennis results in my Club, the Regional Centre's and/or Tennis NZ newsletters and on their websites;
4. Selecting and naming publicly players, officials and teams to represent the Club, the Regional Centre and Tennis NZ at tennis events;
5. If I agree providing me with information and activities relating to my Club, the Regional Centre and Tennis NZ and other tennis matters;
6. If I agree enabling sponsors and funders of my Club, the Regional Centre and Tennis NZ to contact me with information about their product and services.
7. Enabling my Club, the Regional Centre and Tennis NZ to comply with any statute, regulation, by-law or other regulatory instrument that requires collection or disclosure of my personal information; and
8. Any other purpose I agree to in writing.
8. Use, Security and Access: I understand that my personal information will only be used for the purposes listed in paragraph 7 and that:
   1. My personal information will be held securely.
   2. I will have access to my personal information.
   3. My personal information will be corrected upon request.
9. Continued Membership: I understand that upon payment of my membership fee/s, I will become a member of my Club and that by paying such fee/s by the due date/s, I will to be a member of my Club, unless I resign or my membership is terminated.

Copies of the constitutions, regulations, policies, manuals and guidelines of the Club, the Regional Centre and Tennis NZ can be obtained by contacting your Club via www.mtc.co.nz, the Regional centre via www.wellingtontennis.org.nz and Tennis NZ via www.tennisnz.com.

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