LMHC Membership Form 2019-20
Please can a Parent/Guardian of any member under the age of 18 complete this form on their behalf.
Full Name *
Your answer
Address Line 1 *
Your answer
Address Line 2
Your answer
Town/City
Your answer
Post Code *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Email Address *
Your answer
Phone (Mobile) *
Your answer
Phone (Home)
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Number *
Your answer
Age at the start of the season (31st August 2019) *
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