CANNING VALE CRICKET CLUB INC. (CVCC) PLAYER REGISTRATION FORM 2015/2016 Season
DATE .............. /….......... /….......... THIS SECTION IS TO BE FILLED IN BY THE PLAYER PLEASE PRINT CLEARLY
SURNAME
_________________________________________________________
FIRST NAME(S)
_________________________________________________________
DATE OF BIRTH
_________ /________ / _________
ADDRESS
_________________________________________________________
SUBURB
__________________________________ POSTCODE ___________
MOBILE PHONE No.
_____________________ EMAIL ____________________________
PARTNERS NAME
__________________EMERGENCY CONTACT NO.:___________
PREVIOUS CLUB (if applicable)
__________________________________________
I state that:­ (Cross Out if Not Applicable)
I am a free agent and able to register for the CVCC.
I am not a suspended person.
I am not un­financial with any other Club, Association or Cricket Body.
I am not registered with any other Cricket Club, Association or Cricket Body. (If so see below)
I agree to abide by the Rules of the CVCC, PCA and their Affiliated Bodies.
I agree to pay the membership fee to join the club for 2015 / 2016.
I agree that details on this form may be provided to the entities listed at the bottom upon a valid request from them only. (#)
Details of the Perth Cricket Association Privacy Policy can be found on www.pca.asn.au.
PLAYER SIGNATURE:__________________________________________ DATE: _______________
2015/2016 Season Details. (Please Circle)
Fulltime 18+ Games Partime 6­18 Games Casual As Required (Up to 6 Games) Fill­in (As Req)
Desired Grade to play:
First XI (competitive)
Recognised Talents: BATSMEN Second XI
BOWLER Wkt KEEPER
One Day Grade TEAM PLAYER
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FOR CLUB REGISTRAR'S / TREASURERS USE ONLY
CVCC PLAYER NUMBER __________
MEMBERSHIP FEES
$_____________ RECEIPT No OTHER
$_____________ RECEIPT No
PCA PLAYER NUMBER:_________________
TOTAL
$ _____________RECEIPT No
PAID: YES NO
CLUB OFFICIAL
_____________________________ SIGN _____________________
PLEASE PRINT AND SIGN NAME
(#) THIS FORM IS TO BE COMPLETED FOR EVERY REGISTERING PLAYER. THE FORM IS TO BE KEPT BY THE CLUB REGISTRAR FOR THE CLUBS RECORDS, AND MAY BE PRODUCED ON DEMAND BY THE PCA, THE CLUB’S INSURERS OR THE ASSOCIATION REGISTRAR.