Please complete all the required (*) fields and the word checker, then hit 'Register' when finished


Personal Details

Forename(s): *
Surname: *
Gender: Male Female *
Date of birth: *
Address: *
Postcode: *
Employment Status: Education Unemployed Employed Retired Other *

Other Details

Disclosure Scotland checked: Yes No Details:
Child Protection qualified: Yes No Details:
Coaching qualifications: Yes No Details:
Umpire qualifications: Yes No Details:
First Aid qualifications: Yes No Details:

Contact Details

Please enter at least one phone number
Home phone:
Mobile phone:
Work phone:
E-mail address: *

Membership and Match Fees

Category Membership Match fees Total
Adults £80 £80 £160
Concession (U-18, unemployed, students) £60 £60 £120
Juniors (U-16 and playing league hockey) £45 £45 £90


I will pay fees of £ by:
Standing Order Cheque (in full) Cash (in full) *