UK Gymnastics Club Registration Form 2010 -2011

* Club Name

* Street Address

* Village / Town / City

* County

* Postcode

* Telephone Number

Mobile Number

* Email Address

Coach / Instructor Information

* Head Coach / Instructor Name

* Qualification

* Address

* Contact Number

CRB Certificate: Expiry Date

* Welfare Officer Name

* Address

* Contact Number

CRB Certificate: Expiry Date

Membership Fees 1st October 2010 - 30th September 2011

Please remember that the prices below do not include the insurance payment. By purchasing our UK Gymnastics Affiliation fees you will also agree to pay the Insurance payment to our Brokers On-Line using the link below. Please insert the number of gymnasts & coaches that you are affilating to UK Gymnastics.

	£1.01 -Child Gymnast Membership (1-7 years)
	£1.01 -Junior Gymnast Membership (8-16 years)
	£1.01 -Adult Gymnast Membershipo (16+ years)
	£9.39 -Coach Membership

Credit Card Information

Our orders are processed by PayPal. Once your form has been submitted you will be forwarded to PayPal where you will then enter in your payment information.

Please don't forget to purchase your INSURANCE by visiting:

Robert Ellis Insurance Brokers
http://www.ellisinsurance.co.uk/page.asp?id=15

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