ACL Club Application Form
Application to become a member of the ACL Chess Club
Name *
Your answer
Surname *
Your answer
Address *
Your answer
Home Telephone *
Your answer
Mobile Number *
Your answer
Email *
Your answer
Date Of Birth *
Your answer
Gender *
Membership *
Do you consider yourself to have a disability? *
The Disability Discrimination Act 2005 defines a disabled person as anyone with ‘a physical or mental impairment, which has a substantial and long-term adverse effect on his or her ability to carry out normal day-to-day activities.
If yes to the above, what is the nature of the disability?
Your answer
Have you played chess before? *
Emergency Contact details *
Please insert the information below to indicate the person(s) who should be contacted in the event of an incident/accident.
Your answer
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