North Wilts HC Membership Application
Please provide answers for the Player
Email *
First Name *
Last Name *
Gender *
Which gender team will you be playing for?
Mobile Phone Number *
Contact number (will be used for club WhatsApp groups as appropriate)
Home Phone Number
Work Phone Number
Postal Address *
Your full postal address (including postcode)
Special requirements
If there are any dietary, allergy, health problems etc. please detail below:
Doctor's information: Name
Name of your Doctor if known
Doctor's information: Surgery *
Name of Doctor's Surgery
Doctor's information: Phone *
Telephone Number of Doctor's Surgery
Emergency Contact information #1 *
Name & Telephone number
Emergency Contact information #2
Name & Telephone number
Preferred playing position
Are you interested in helping the club with...
Is the player / member under 18? *
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