Online Membership CRICKET SECTION SENIOR ONLINE MEMBERSHIP FORM Once this form is submitted you will be re-directed to the club shop. This enables you to pay your club membership safely and securely. * required fields If you are human, leave this field blank. Full Name * Contact Tel. No. * Date of Birth * E-mail Address * Address * Postcode * EMERGENCY CONTACT NAME * CONTACT TEL. NO. * DETAILS OF ANY MEDICAL CONDITIONS * Please put n/a if none apply TYPE OF MEMBERSHIP (please select which is applicable) * Social Membership Non Playing Member 18 or over but receiving full-time education or unemployed 18 or over Paid-up Life Member (playing) DIGITALLY SIGN & THEN SUBMIT THE FORM * I confirm that I have received a copy of Stafford Cricket & HockeyClub's Code of Conduct for Members & Guests and agree to abide by it.