Cross Word 2018 Leader Registration
I'm signing up to be a *
First name *
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Last name *
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Gender *
Age *
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Date of birth (dd/mm) *
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Email address *
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Cell number *
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Home/work number
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Emergency contact name *
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Emergency contact number *
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Dietary requirements
Please note we may not be able to cater for all food allergies, but we will do our best.
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Medical aid details
Name of scheme, membership number, policy holder.
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