Club Membership Registration Form

Club Membership Form

Complete the form below to sign up for our online membership service.
Name

PrefixFirst NameLast Name
E-mail
Home Phone:

Area CodePhone Number
Mobile Phone
Phone Number
Address:

Street Address

Street Address Line 2

CityState / Province

Post Code
Birth Date:

MonthDayYear
Gender

FemaleMale
Marital Status

SingleMarried
Preferred Payment Method

Monthly
Monthly Membership*
Partners Name

First NameLast Name
Partners Birth Date:

DayMonthYear
1st Child Name

First NameLast Name
1st Childs Birth Date:

DayMonthYear
2nd Child Name

First NameLast Name
2nd Childs Birth Date:

DayMonthYear
Start Date

DayMonthYear
Date
Health & Safety

To be completed for all Full & Gym Only Applicants
Western Lawn Tennis and Squash Club Gym wish to maintain a very high standard of Health & Safety, therefore we must establish your current health status prior to assisting you to improve your fitness. There are a small number of people who should have medical advice concerning the type of activity most suitable, and the questions below will address this issue.
1. Have you been told by a doctor that you have a heart condition and should only undertake medically supervised activity?

YesNo
2. Do you have chest pain brought on by physical activity?

YesNo
3. Have you developed chest pain in the last month?

YesNo
4. Do you suffer from dizziness causing you to fall over or lose

YesNo
5. Has a doctor ever recommended medication for your blood pressure or a heart condition?

YesNo
6. Do you suffer from Diabetes Mellitus, epilepsy or asthma?

YesNo
7. Are you currently taking any medication that may affect your ability to exercise?

YesNo
8. When at rest or after slight exertion, do you suffer from breathlessness?

YesNo
9. Are you pregnant or is there a possibility you may be?

YesNo
10. Are you unaccustomed to regular exercise and over 65 years of age?

YesNo
11. Do you have a bone or joint problem that could be made worse through a change in your physical activity?

YesNo
12. Through your own experience, or after a doctors advice, are you aware of any physical reason against your exercising without medical supervision?

YesNo
Where did you hear about us?

An Existing MemberTuscan TennisGoogleNews ArticleOther
MEMBERSHIP

We have several types of Gym only and Gym/Squash/Tennis memberships available to new members.
1. Joining Fee £50.00
2. Individual Senior: adults aged 18+ year
3. Couple: two cohabiting adults aged 18+ years
4. Golden Individual: adult aged 65+ years
5. Golden Couple: two cohabiting adults aged 65+ years
6. Family: up to two adults and two children
7. Student: full-time student aged 18+ years (student ID required)
8. Junior: ages 14-17 (gym membership), ages 0-8 and 9-17 (tennis/squash)
9. Off Peak: (gym only) Monday to Friday 7am-5pm, Saturday & Sunday after noon
10. Country: members living more than 30 miles from the club
Membership Rules

I have read, understood, and accepted the rules for membership.
Privacy Policy
Once you submit your application, we will contact you shortly to complete your membership application.

Thank you!
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Club Membership Form

Health & Safety

Privacy Policy