Registration Form

Personal Details = required

Full Name

Home Address

Home Phone

Work/Other Phone

Mobile Phone

Email Address

Alternate Email

Date of Birth

Gender

Male Female

Occupation

(Please indicate if you would be willing to help the club should it need your expertise.)

Membership Start

When would you like your membership to start?

As Soon As Possible Specific Date

Preferred Start Date
(if applicable)

Membership Category

Please select your preferred membership category

	Category	Cost

Bowls Section

	Category	Cost
	Bowls Member Only available to people aged 16 or over.	£0.00
	Bowls Non Member	£0.00
	Bowls Social Member	£0.00
	Bowls Junior Member Only available to people up to the age of 15.	£0.00

Field Maintenance Section

	Category	Cost
	Field Maintenance People who help maintain the playing fields	£0.00

Football Section

	Category	Cost
	Football: EBFC Junior Junior member of Elloughton Brough Football Club	£0.00
	Football: EBFC Senior Senior member of Elloughton Brough Football Club	£0.00
	Football: AFC Blackburn Leisure Member of Blackburn Leisure Adult Football Club	£0.00
	Football Coach	£0.00

Squash Section

	Category	Cost
	Squash Adult Membership - Annual Single adult member of the squash section Only available to people aged 19 or over.	£84.00
	Squash Adult Membership - Monthly Single adult member of the squash section, paid monthly on a repeat-billing basis. Only available to people aged 19 or over.	£7.00
	Squash Senior School Membership Young Adult (12-18) Only available to people between the ages of 12 and 18 inclusive.	£36.00
	Squash Primary School Membership Junior (5-12) Only available to people between the ages of 5 and 12 inclusive.	£24.00
	Squash Pre-Primary Membership Mini (<5) Only available to people up to the age of 4.	£0.00
	Squash Coach - Perpetual Squash coaching team to have read-only view Only available to people aged 17 or over.	£0.00
	Squash Couple Membership - Annual 2 adults in a relationship Only available to people aged 19 or over.	£144.00
	Squash Couple Membership - Monthly 2 adults in a relationship, paid monthly, on a repeat-billing basis. Only available to people aged 19 or over.	£12.00
	Squash Family Membership - Annual 2 adults with a maximum of 4 children Only available to people aged 19 or over.	£192.00
	Squash Family Membership - Monthly 2 adults with a maximum of 4 children, paid monthly, on a repeat-billing basis. Only available to people aged 19 or over.	£16.00

Data Protection

I understand that any personal data I provide on this site will be processed in accordance with the Terms & Conditions and Privacy Policy. I have read and agree to the Terms & Conditions (https://blackburnleisure.myclubhouse.co.uk/Home/TermsAndConditions) and the Privacy Policy (https://blackburnleisure.myclubhouse.co.uk/PrivacyPolicy;).

Signature

Date

Please return completed forms to: Blackburn Leisure, Blackburn Social & Community Club, Prescott Ave,, Brough,, HU15 1BB

Use this form to send an email to another member. You may only send to one member at a time. Your registered email address will be passed on to this member but you may also include alternative contact details.

Note: Emails sent via the website are not entirely private. A copy of every email is held on the database and this can be accessed by the club officers using the Sent Emails page.

From

Alternative contact email

Another email address which the recipient can use to contact you.

Alternative contact details

Other contact details which the recipient can use to contact you e.g. phone number.

Subject

Message

Copy this message to my email address

Solid

Regular

Light

Duotone

Brands

No matching icons.

Title

Description

Requested Membership Subscriptions

One or more of the requested Membership applications require approval. You will be emailed if your request has been approved and, at that point, you will be able to view and accept or reject the membership offer and proceed with payment. will be emailed once the request has been approved and, at that point, they will be able to view and accept or reject the membership offer and proceed with payment.

Subscriptions have been automatically approved and have been added to your basket. Please now proceed there to make payment.

Pay for Subscriptions

Reference	Name	Category	Costs
			Joining Fee Cost /	View Manage

Group Subscriptions

- :

You have requested one or more group membership subscriptions. You should now use the register buttons below to add additional members into the available slots.

No.	Membership
	One of:

Next Steps

{"HeaderName":"RequestVerificationToken","RequestToken":"CfDJ8LKACIpBacJLvb3Ih0OHjeVKBWRuFXgXPauVmZVYKM5Fd8X5D3p3Qs3vCFuNv7-kxRUbv4sHjbi4DNVUEtG8ex3gw9DZw2EIDSHSrYQwAdSw3IICChPbrAkygCuZchq_spJhuLWTFe5d0xS7yNm_roY"}

Outdated Browser

Sandbox Mode