Juvenile Registration

New Members ONLY

Please note that your application for membership needs to be confirmed by a member of the Juvenile Committee before submitting this form or transferring funds.

When completing the form please note:

One form is needed for each Athlete
Remember to put your name/your child's name on the Bank Transfer.

New or Existing Member *Existing MemberNew Member

Male / Female *MaleFemale

Athletes Name *Email Address *Birth Date *

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Address

Street Address Line 1 *Street Address Line 2 *Street Address Line 3 *Eir Code *

Parents Details

Parent Name *

Parent Contact Number *

Home Phone Number

Parent Name 2 *Parent Contact Number 2 *County of Birth *Are there any medical conditions the club should be aware of? *

This includes asthma, allergies, diabetes or difficulty in concentration. Please supply details, including details of medication your child may need at training (eg asthma inhaler, insulin)

Bank Account Details

Membership Fees:

1st Child - €120
Any subsequent child - additional €90 each
Family Membership - €275

93-32-95-01275094

BIC: AIBKIE2D

IBAN: IE14AIBK93329501275094

Are there any medical Please specify which Payment Method you have used *

We would really appreciate if you could pay subs into our Bank Account. This is safer and makes it so much easier for us to manage. Again, please remember to put your name/your child's name on the Bank Transfer.

I Paid into Bank Account as AboveI am unable to pay into Bank Account but will pay by Cash/Cheque on Registration Night

Confirm Date when Payment to Bank Account was Made *

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