Cannon Hill Anglican CollegeTennis ProgramClasses commence Friday, April 26

COST: $16.50 (Hot Shots) | $22.00 (Squad)

Development Squad: Friday 3.15pm - 4.45pmHot Shots Coaching: Monday 7.15-8.00am

We require all players to formally register in our coaching program by providing your contact details and payment instructions for your tuition fees and membership fees. Tuition fees are charged fortnightly by direct debit and it is necessary to complete this form once as it remains current until cancelled. Please note that you are required to complete a new form if your contact details or payment instructions change.

Player/s Name: …………………………………………............……..…. Birth Date/s: ……/……/….… Male Female

Parents Name (if applic): ……..…………………………….. Mobile: .…………………..……….Home: ….………………..…..

Street Address: ………….……………………………………………. Suburb: …………..…………..… Postcode: ……….....

EEmail: .………………………..…….………..….. Lesson Day & Time: ……………………….. Lesson Type: ………….............…

I/we authorise payment of tennis coaching fees as outlined below and in accordance with the DDR agreement on the reverse side of the form. The coaching program runs for 40 weeks per year, coaching tuition fee payments are charged fortnightly and can be cancelled at any time with 14 days written notice as per the DDR agreement. No payments are charged during State School Holiday periods or for Public Holidays. Fortnightly program fees for 2013 are listed below and will be reviewed each January. Members of the Morningside Tennis Centre receive a 10% discount off Private Lessons (DD payments only).

PPayment from Bank, Building Society or Credit Union

Financial Institution: …………..………………………………………………… Branch: ……………….……………………………………

Name of Account Holder(s): ...……………………..……………………………………………………………………………………………

BSB Number: ………………………….…………………….. Account Number: .…………………...………………………………..………...

I/We authorise Ezidebit Pty Ltd ACN 096 902 813 (User ID Number 165969) to debit my/our account listed above through the Bulk Electronic Clearing System (BECS) in accordance with the debit arrange-ment above and as per the Ezidebit DDR Service Agreement provided. Please note a transaction processing fee of 55c applies.

__________________________________________________________ OR ________________________________________________________________

Payment from Credit Card Card Type: Visa Mastercard Amex Diners

Card Number: …………………………………………………………………………………. Expiry Date: …………………….……………

Name on Card: ……………………………………………………………………………………………………………………………….

BBy signing this form, I/we authorise Ezidebit Health & Fitness Newstead acting on behalf of the business to debit payments for tennis lesson from my credit card listed above and I/We acknowledge that Ezidebit will appear as the merchant on my credit card statement. I/We agree to reimburse Ezidebit and indemnify Ezidebit for any successful claims made by the Card Holder through their nancial institu-tion against Ezidebit. Please note that a transaction processing fee applies of the greater of $0.55c or 2% on Visa & Mastercard or 4% on Amex & Diners Card.

TThis authorisation is to remain in force from this date and will continue in accordance with the DDR agreement on the reverse page which I/we have read and understood. The administration of this agree-ment is conducted by Ezidebit Health & Fitness Newstead as a billing agent only.

1. …………………………………………………. 2. …………………………………………. Date: / / Signature(s) of account or card holder(s)

FOR MORE INFORMATION PLEASE CONTACT OUR STAFF

07 3899 8110

CANNON HILL ANGLICAN COLLEGE