LMHC Membership Form 2020-21
Please can a Parent/Guardian of any member under the age of 18 complete this form on their behalf.
Full Name *
Address Line 1 *
Address Line 2
Town/City
Post Code *
Date of Birth *
MM
/
DD
/
YYYY
Email Address *
Phone (Mobile) *
Phone (Home)
Emergency Contact Name *
Emergency Contact Number *
Age at the start of the season (31st August 2020) *
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