Online Application West Mersea Bowls Club - Application for Membership TYPE OF MEMBERSHIP Please select the type of membership you require * Select… Winter Indoor Only (October - April) £80 Summer Outdoor Only ( May - September) £80 Winter Indoor and Summer Outdoor ( October - September) £160 Winter Indoor and Summer Indoor ( October - September) £160 Summer Indoor Only (May - September) £40 (must also be Winter Indoor or Social member) Junior Member (October - September) £10 Social Member £20 Title * Title Mr. Mrs. Ms. Miss Dr. Other First Name * Surname * Address * Preferred contact telephone number (inc code) - Home or Mobile * Email Address Note: All internal club communications are by email Date of Birth * We are asked by the governing bodies for Bowls, and Sport England, to provide membership profile information. This is only ever provided in aggregate form, but we do need: Which of these best describes your ethnic group? * Select… White British White Irish White Other Mixed White & Black Carribbean Mixed White & Black African Mixed White & Asian Mixed Other Asian Indian Asian Pakistani Asian Bangladeshi Asian Other Black or Black British: Carribbean Black or Black British: African Black or Black British: Other Chinese Other Ethnic Group Prefer not to say Do you consider you have a disability? (Please tick any that apply) * Select… 0. No long-standing illness or disability 1. Vision (due to blindness or partial sight) 2. Mobility (difficulty walking short distances, climbing stairs, lifting or carrying objects) 3. Hearing (due to deafness or partial hearing) 4. Learning or concentrating or remembering 5. Mental Health 6. Stamina or breathing difficulty 7. Social or behavioral issues (due to neuro diverse conditions such as Autism, Attention Deficit or Asperges Syndrome) 8. Difficulty speaking or making yourself understood 9. Dexterity difficulties (lifting, grasping or holding objects) 10. Long-term pain or discomfort (that is always present or reoccurs from time to time) 11. Other Prefer not to say If you would like to tell us of another disability please do so here. Select… 1. Vision (due to blindness or partial sight) 2. Mobility (difficulty walking short distances, climbing stairs, lifting or carrying objects) 3. Hearing (due to deafness or partial hearing) 4. Learning or concentrating or remembering 5. Mental Health 6. Stamina or breathing difficulty 7. Social or behavioral issues (due to neuro diverse conditions such as Autism, Attention Deficit or Asperges Syndrome) 8. Difficulty speaking or making yourself understood 9. Dexterity difficulties (lifting, grasping or holding objects) 10. Long-term pain or discomfort (that is always present or reoccurs from time to time) West Mersea Bowls Club registers all playing members with the National governing bodies, County and local bowling associations. Our Privacy policy is on display in the clubhouse. * I understand We share contact phone numbers with members to help everyone actively participate in the sport and other related events. Please let us know if you object to this. * I understand We like to keep you fully informed of what's happening at the club. Please "check" all ways you are happy for us to contact you * Email Phone Post We regularly take photos to record events and help promote the club and the sport. Please "check" if you're happy for us to do this * I'm ok with that No, I don't want my picture taken thank you. Payment options: Bank transfer to "West Mersea Bowls Club" Sort code 20-22-67 Account no. 00018937 Reference: your name eg "Jo Bloggs" Cheque payable to "West Mersea Bowls Club" Please indicate how you are paying please * Select… Bank transfer Cheque I agree to abide by the rules and regulations of West Mersea Bowls Club as described in the Constitution (see link below) * Agreed Signature * Date * West Mersea Bowls Club Consitution