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BNB Membership form
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* Indicates required question
Name
*
Your answer
Date of Birth
*
Your answer
Gender
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Choose
Male
Female
Neutral
Postal Address
*
Your answer
Email Address
*
Your answer
Contact number
*
Your answer
Emergency contact's name
*
Your answer
Emergency contact's number
*
Your answer
Name of bank
*
Your answer
Bank account holder's name
*
Your answer
BSB Number
*
Your answer
Account Number
*
Your answer
Debit frequency (I suggest choosing the same frequency that you get paid)
*
Choose
Weekly
Fortnightly
Monthly
Day or date for first debit to be taken (I suggest choosing the day after your payday)
*
Your answer
I agree & consent to the BNB Gym Rules and BNB Waiver found at the bottom of this page
*
Yes
Required
BNB Gym rules:
www.brisbanenorthbarbell.com/gymrules
BNB Waiver:
www.brisbanenorthbarbell.com/waiverinfo
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