Membership Application

Membership form 2024

Are you a New/Existing member:
New member Existing member

First Name *

Last Name *

Date of Birth *

E-mail *

Cell Phone # *

Home Phone #

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Country *

Player Availability

What type of membership are you applying for? *

Player Specialty *BatsmanBowlerWicket keeper/Batsman

Emergency Contact

First Name *

Relationship *

Phone # *

Medical History

Does the player have any existing medical condition that may be relevant?

Waiver and Release of Liability, Code of Conduct

Waiver checkbox *I have read the Waiver

Code of conduct checkbox *I have read the Code of Conduct

Player/Parent Consent

DCCC By laws *I hereby signify my willingness for the above mentioned player to play with the Club and to accept the conditions and rules pursuant to the Bylaws of Durham Champions Cricket Club

Payment Method*

We request you to please fill the application and pay the membership fees in full amount under 5 business days by Interac e-Transfer (email transfer) to durhamchampionscc@gmail.com. If you have any questions related to membership, please contact Aditya Singh (Treasurer/Membership Secretary) by email at durhamchampionscc@gmail.com or Phone/Text at +1(437) 450-3222 (DCCC)/+1(416) 389-6569 (Shishir)

Please do not fill in this field.

Membership ID/SN# *0 / 6

First Name *

Last Name *

Date of birth *

E-mail *

Does the player have any existing medical condition that may be relevant?

Waiver and Release of Liability, Code of Conduct

Waiver checkbox *I have read the Waiver

Code of conduct checkbox *I have read the Code of Conduct

Player/Parent Consent

DCCC By laws *I hereby signify my willingness for the above mentioned player to play with the Club and to accept the conditions and rules pursuant to the Bylaws of Durham Champions Cricket Club

Payment Method*

We request you to please fill the application and pay the membership fees in full amount under 5 business days by Interac e-Transfer (email transfer) to durhamchampionscc@gmail.com. If you have any questions related to membership, please contact Aditya Singh (Treasurer/Membership Secretary) by email at durhamchampionscc@gmail.com or Phone/Text at +1(437) 450-3222 (DCCC)/+1(416) 389-6569 (Shishir)

Please do not fill in this field.

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