Membership form - Bath Lacrosse

Name *

First

Last

Date of Birth *

dd/mm/yyyy

Gender *

Male/Female/Prefer not to say

Address *

Please include post code

Contact Phone number *

Number of Responsible Adult if U18

Email *

If U18 this must be the e mail for the responsible adult

Membership category *

All players, officials and coaches must be registered with England Lacrosse (individual registration at https://www.englandlacrosse.co.uk). *

England Lacrosse registration number

Please confirm that you have registered with England Lacrosse as a member of Bath Lacrosse Club *

Yes

Lacrosse qualifications

Other qualifications

Sports related qualifications

Name and relationship to minor if completing for U18

Bath Lacrosse Club would like to store lacrosse related imagery of you (or the minor named above) for use in promotional material in support of lacrosse club activities. Please select as many choices as is appropriate * *

I consent to the use of my imagery in club marketing material
I consent to the use of my imagery on club social media
I consent to the use of my imagery on the club web site
I DO NOT consent to the use of my imagery

You confim that you will abide by the constitution of Bath Lacrosse Club (published at http://www.bathlacrosse.com) *

Yes

You understand that Committee members, on behalf of Bath Lacrosse Club, will retain membership information for the duration of the current season and will not share this information with any third parties without your prior consent * *

I Understand

Comments or Messages

Date you completed this form *