|
Middleton Curling Club
6 King Street, P.O. Box 421
Middleton, NS B0S 1P0
Tel: (902) 825-3225
Email: curling@middletoncurlingclub.com
|
|
|
|
|
|
|
|
|
|
|
|
|
Please complete this electronic form and submit by clicking the "Submit" button below.
This information will be forwarded automatically to the club's email account.
|
|
|
|
2011-2012 INFORMATION AND MEMBERSHIP APPLICATION FORM
|
|
|
|
|
|
|
* Name:
|
|
|
|
|
|
|
|
|
|
|
|
|
Male
|
|
|
|
|
|
|
Female
|
|
|
Gender:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
8-12
|
|
|
|
|
|
|
|
|
|
|
Age Group:
|
|
|
|
|
13-19
|
|
|
20-29
|
|
|
|
40-49
|
|
|
50-59
|
|
|
60-69
|
|
|
70-79
|
|
|
80+
|
|
|
|
|
|
|
|
|
|
|
30-39
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
* Home Phone:
|
|
|
|
|
|
WorkPhone:
|
|
|
|
|
|
|
|
|
|
|
|
|
* Mailing Address:
|
|
|
|
|
|
|
|
|
|
* Civic Address:
|
|
|
|
|
|
|
|
|
|
* Email Address:
|
|
|
|
|
|
Curling Programs 2011-2012
Please check which of the following curling programs you wish to join:
|
|
|
|
|
|
|
|
Open League – Monday 7:00 pm and Tuesday 7:00 pm (teams and individual entries)
|
|
|
|
|
|
|
|
|
Mixed League - Thursday 6:30 pm & 8:30 pm – (teams and individual entries)
|
|
|
|
|
|
|
|
|
Seniors Day Curling League - Monday and Wednesday 1:00 pm (individual entries)
|
|
|
|
|
|
|
|
|
Junior Curling League
|
|
|
|
|
|
|
|
|
Little Rock Curling League
|
|
|
|
|
|
|
|
|
Commercial League - Wednesday 7:00 & 9:00 pm – (teams and individual entries)
|
|
|
|
|
|
|
|
|
|
Associate Membership
|
|
|
|
|
|
|
|
|
|
1700 Club Membership
|
|
|
|
|
|
Please indicate below whether you are applying as an individual curler or as a team member.
All individual curlers will be placed on a team.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Individual Curler
|
|
|
Lead
|
|
|
|
|
Skip
|
|
|
|
Open League:
|
|
|
|
Position preferred:
|
|
|
|
2nd
|
|
|
Mate
|
|
|
|
|
Any
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Team Member
|
|
Name of Open League Team's Skip:
|
|
|
|
|
|
|
|
|
|
|
|
|
Name of Open League Team's Mate:
|
|
|
|
|
|
|
|
|
|
Name of Open League Team's Second:
|
|
|
|
|
|
|
|
|
|
Name of Open League Team's Lead:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Individual Curler
|
|
|
Lead
|
|
|
|
|
Skip
|
|
|
|
Mixed League:
|
|
|
|
Position preferred:
|
|
|
|
2nd
|
|
|
Mate
|
|
|
|
|
Any
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Team Member
|
|
Name of Mixed League Team's Skip:
|
|
|
|
|
|
|
|
|
|
|
|
|
Name of Mixed League Team's Mate:
|
|
|
|
|
|
|
|
|
|
Name of Mixed League Team's Second:
|
|
|
|
|
|
|
|
|
|
Name of Mixed League Team's Lead:
|
|
|
|
|
|
|
Would you, as an individual curler, like to have your name placed on the “spare” list?
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Yes
|
|
|
No
|
|
|
|
|
|
|
|
|
|
Which League(s):
|
|
|
Open
|
|
|
Mixed
|
|
|
Commercial
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
How would you rate your curling skill?
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
None (never curled)
|
|
|
Basic
|
|
|
Average
|
|
|
Above Average
|
|
|
Advanced
|
|
|
|
|
|
|
|
|
|
How many years curling experience do you have?
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
None
|
|
|
|
|
|
|
|
|
|
|
1 Year
|
|
|
2 to 5 Years
|
|
|
6 to 10 Years
|
|
|
11 to 20 Years
|
|
|
Too many to remember.
|
|
|
|
|
|
|
|
|
|
|
|
What team positions are you willing to play?
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Lead
|
|
|
2nd
|
|
|
Mate
|
|
|
Skip
|
|
|
|
|
|
|
|
|
Anything else you want to say? Enter it here.
|
|
|
|
|
|
|
|
 |
|
|
|
2011-2012 Dues Structure ( All Membership fees below include HST )
|
|
|
|
|
|
|
|
|
Active Member
|
|
|
$250.00
|
|
|
$240.00
|
|
(Debenture holder only)
|
|
|
|
|
|
|
|
|
|
|
|
Associate Member
|
|
|
$55.00
|
|
|
$45.00
|
|
(Debenture holder only)
|
|
|
|
|
|
|
|
|
|
Novice Adult
|
|
|
$148.00
|
|
(Full Season)
|
|
|
|
|
|
|
|
|
Mature Student
|
|
|
$55.00
|
|
|
|
|
|
|
|
|
Two Month Trial
|
|
|
$55.00
|
|
(Nov - Dec)
|
|
|
|
|
|
|
|
|
Junior Curler
|
|
|
$45.00
|
|
(First family member)
|
|
|
|
$20.00
|
|
(Each additional family member)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Little Rock Curler
|
|
|
$30.00
|
|
(First family member)
|
|
|
$15.00
|
|
(Each additional family member)
|
|
|
|
|
|
|
|
|
|
1700 Club Member
|
|
|
$25.00
|
|
|
|
|
|
Payment of dues is expected by November 15, 2011.
Payment by cheque is preferred. Make cheque payable to Middleton Curling Club.
Deliver payment to Allen Morris, Cindy Robar, Sue Palmer, by mail, or to the om duty bar tender.
|
|
|
|
 |
|
|
|
To assist in League planning and calculating N.S.C.A. fees, please submit this application as soon as possible.
Any questions? Call Cindy Robar at 825-2347 or email her at tcrobar@eastlink.ca
|
|
|
|
|
|
|
|
|
|
|
* = Required Information. "Submit" will be disabled until supplied.
|
|
|
|
|
|
|
|
|
|
