Cumann Luthcleas Gael
Clúain Dá Ghád
Membership Application Form 2016
1. Please tick Membership Option:
Membership Rates 2016 (Fee includes registration fee and insurance)
Option
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
Tick
Adult Player
Adult Player with 12 month lotto
Adult Player with Lotto & 1 Race night entry
Student/Unemployed Player
Student/Unemployed Player with Lotto
Student/Unemployed Player with Lotto & 1 Race night entry
Player U18
Player U18 with lotto
Player U18 with lotto & 1 Race night entry
Non Playing Member
Non Playing Member with lotto
Non Playing Member with lotto & 1 Race night Entry
Non Playing Couple
Non Playing Couple with Lotto
Non Playing Couple with Lotto & 1 Race night Entry
Family (Children U18)
Family Membership (2 ADULTS & CHILDREN U18) with Lotto and 1
race night entry. Please Fill the attached Family Membership Form also.
NOTE: Family membership only allows 4 entries to club draws.
18
2. Please populate the following if availing of Lotto / Race night option above:
Please select four numbers between 1 and 28 for entry into the weekly Lotto Draw.
Four Numbers between 1 & 28
Please enter names of Horse, Owner & Jockey for inclusion in the Annual Race Nite
Owner
Horse
Jockey
€60
€150
€160
€30
€120
€130
€30
€120
€130
€30
€120
€130
€30
€120
€130
€60
€150
3. Membership details:
1. Each applicant must fill in an application form.
2. Any player not registered will not be eligible to play for the club.
3. Application form will not be accepted without the correct fee.
Name (Block Capitals) _______________________
Address ___________________________________________________________
Signature of applicant ____________________________
(Or Parent /Guardian if U18)
Name in Irish __________________________________
Date of Birth___________________________________
Medical History ____________________________________________________
Contact Number___________________
email address _____________________
4. Please complete if you are joining as a FAMILY MEMBER:
FAMILY MEMBERSHIP APPLICATION
option only
€150 - This Sheet Applies to the Family Membership
Please provide information below for those members of the family that you would like to be registered as club members.
Please ensure additional details are completed for under 18 playing members. Note: This offer does not cover adult
playing members over 18 years of age.
Non Playing Member Names (Block Capitals)
1. _____________________Contact No :_____________email address____________
2. _____________________Contact No :_____________email address____________
Under 18 Playing Members
(Any Number)
Signature of Parent/Guardian
Name
Name in Irish
Date of Birth
Medical History __________________________________________________
Address _________________________________________________________
Please tick this box if you don’t want your childs photo to be shown on club material i.e. website etc.
5 – Club Administration activities
Can applicants wishing to help support club administrative activities please
Tick items below they would be most interested in helping with.
Fundraising , Training ,
Lotto 
Other 