Membership Application Form

Name (required):

Address (required):

Sex:

Date of Birth (required):

Your Phone (required):

Your Email (if any):

Previous Club (if any):

Reg. Number at previous club:

Type of Membership

For family membership, please provide names of other family members

For juvenile membership, please provide the following information

Your GP Name (required):

Allergies etc. (required):

Preferred Method of Payment:

I agree to comply with the rules of the club. I agree to bind by the rules of the Pitch & Putt union of Ireland. I understand that my membership may be reviewed at any time.

I understand my personal information as pertained above will be used by the club to meet PPUI registration requirements. I understand that if I do not provide my personal data my membership cannot be registered with either the club or the PPUI.

I understand that photographs may be taken during or at sport related events and may be used in the promotion of the sport.