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Online Entry Facility for 2011-2012

Mens Leagues Application Form

The following membership form can be completed and submitted online. After verification it will be emailed to the convenor who will review it and email confirmation to the sender, including the amount due and payment arrangements. The information collected is for the sole use of Deer Lodge Curling Club. It will be used for the Roster and comunication with members re Club matters. It will not be used otherwise except with the written permission of the member.

General Information - * Indicates Required Field

*	Last Name:
*	First Name:
*	Address:
*	City:
*	Postal Code:
*	Home Phone:
	Business Phone:	Ext.
	Business Name:
*	Email Address:

*	Curl Manitoba Affiliation Information ($4.00 fee, GST inc)	Official Language :French English Gender :Female Male Year of Birth :

	I arranged to curl with	Name of skip: on draw-night:
	--(and if applicable)	Name of skip: on night2:
	or
	Please place me on a rink	My preferred playing position : and my preferred draw-night:

*	Yes No	DLCC is run by a volunteer board who could use help with certain events. Can we count on you ?


*	Membership Selection	Choose one item from only one Category: A, B, C or D depending on your shareholder status.

A $20 WindUp Ticket is included in the "Regular Curler" fees.
A WindUp Ticket is not included in "5th man", "Associate" or "Clubhouse" fees.
Adult Non-shareholders fees include an assessment towards purchase of a share.
A share will be issued after 6 consecutive active years as a Club curling member.
The "Regular" rates shown below do not reflect the pre June 30 discount.
ANY NEW TEAM curling for the first time at DLCC will get the special pre June 30 discount rate
regardless of their application date.

Membership Category		Fee + GST	Total Due
	Category A - Shareholder of Deer Lodge
	Regular Curler 1 Night a week	$ 235.00 + 11.75	$ 246.75
	Regular Curler 2 Nights a week	$ 375.00 + 18.75	$ 393.75
	5th Player on a team 1 Night a week	$ 110.00 + 5.50	$ 115.50
	5th Player on a team 2 Nights a week	$ 175.00 + 8.75	$ 183.75
	Associate member (spare)	$ 110.00 + 5.50	$ 115.50
	Clubhouse member (no curling priviledges)	$ 25.00 + 1.25	$ 26.25

	Category B - Non-Shareholder
	Regular Curler 1 Night a week	$ 255.00 + 12.75	$ 267.75
	Regular Curler 2 Nights a week	$ 395.00 + 19.75	$ 414.75
	5th Player on a team 1 Night a week	$ 130.00 + 6.50	$ 136.50
	5th Player on a team 2 Nights a week	$ 195.00 + 9.75	$ 204.75
	Associate member (spare)	$ 130.00 + 6.50	$ 136.50
	Clubhouse member (no curling priviledges)	$ 25.00 + 1.25	$ 26.25

	Category C - Student 18 and under
	Regular Curler 1 Night a week	$95.00 + 4.75	$ 99.75
	Regular Curler 2 Nights a week	$ 180.00 + 9.00	$ 189.00
	5th Player on a team 1 Night a week	$ 70.00 +3.50	$ 73.50
	5th Player on a team 2 Nights a week	$ 130.00 + 6.50	$ 136.50
	Associate member (spare)	$ 70.00 + 3.50	$ 73.50

	Category D - Young Adult 18-21
	Regular Curler 1 Night a week	$ 165.00 + 8.25	$ 173.25
	Regular Curler 2 Nights a week	$ 270.00 + 13.50	$ 283.50
	5th Player on a team 1 Night a week	$ 90.00 + 4.50	$ 94.50
	5th Player on a team 2 Nights a week	$ 140.00 + 7.00	$ 147.00
	Associate member (spare)	$ 90.00 + 4.50	$ 94.50

Other Information- Skips please complete
If you are the skip of a team(s) please list your other rink personnel :
on draw-night:
Third: Second: Lead: 5th Person:

-and if applicable-
on draw-night2:
Third: Second: Lead: 5th Person:

Team Locker : if you have one already, provide Locker # :
One person from team please pay the $20 (+ $1.00 GST) fee.
Should we bill you ? Yes No

*******************************************************
YOU CAN NOW PROCEED TO THE NEXT STEP :

If you choose to "Continue" , the application will be validated.
Following validation you will be given the option to either return to this screen to make changes
or to submit the application to the convenor via a pre-filled email message.

If you have comments please forward these via email to the Webmaster .

Last modified: Jul 12, 2010, 8:00 pm