Registration

If you would like to join the Selwyn Hockey Club, please fill out this registration form or print out our registration form and sent it completed to:

Selwyn Hockey Club Inc.
PO Box 8067
Christchurch

First names
Surname

Date of Birth
Occupation
Place of study	(if a student, please name educational facility)

Address

Home Phone		Work Phone
Cell Phone

Email
	Please tick if you do not wish Canterbury Hockey to be advised of your email address

If not a student, please tick grade you play in
	Open Grade
	Grass Grade
	Mid-week Open

2012 Season Subscriptions
Open Grade Mid-week open Tertiary Student Secondary Student Grass Grade		$360.00 $300.00 $300.00 $210.00 $235.00	A $50 Late Payment Penalty Fee will apply to all subscriptions unpaid by 30 June 2012, unless paying by automatic payment and the first payment is made and the Treasurer notified.

PLUS turf fees if applicable. These will be set once notification of sponsorship has been received.

As the Selwyn Hockey Club Inc. is a corporate member of the Riccarton Club Inc., all adult (over 18yrs) members of the Selwyn Hockey Club Inc. become automatic members of the Riccarton Club Inc. and entitled to all Riccarton Club Inc. privileges. Information regarding facilities available to members of the Riccarton Club Inc. is available on request.

Pursuant to the Privacy Act 1993, I authorize the disclosure of personal information as stated on the Selwyn Hockey Club Inc. registration form to: Riccarton Club Inc. Canterbury Hockey Association Inc.