Form Page: bptc_thailand

Burnside Park Tennis Academy Registration

This registration is for the BPTA 2012 Thailand Coaching Trip, and is exclusively for BPTC Members

Non-members must pay a rest-of-the-year subscription and become members of Burnside Park Tennis Club to be eligible to particpiate in this BPTA 2012 trip.

Membership Status

Method of Payment

Family Name

Given Names

Date of Birth

e-Mail Address

Passport Number

Date of Issue

Expiry Date

Physical Address

Mobile #

Landline #

Special Instructions etc.

An e-Mail will be sent to you immediately to confirm your registration, and we will be in touch with you shortly
thereafter to advise details of your participation in this exclusive BPTA trip ....
PLEASE NOTE: If it is your intention to use Internet Banking the account details are as follows ...
Burnside Park Tennis Academy (Gareth Robb), National Bank of New Zealand, Account # 06-0665-0151348-01

Enter this code in the box below

Click here to refresh the code .....