Miguel Llera International Football Academy
Membership Booking Form (12th Block 2018)
Miguel Llera International Football Academy
Full Name *
Your answer
Date of Birth. *
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DD
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YYYY
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Required
Player Position *
Medical Details *
Your answer
Parents Name *
Your answer
Home Address *
Your answer
Home Phone Number *
Your answer
Email Address *
Your answer
Emergency Phone Number *
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Another Phone number *
In the event that the above named person cannot be reached, please give extra emergency contact name and number
Your answer
Dates&Timing *
Booking *
Authorise the use of still or moving images for the use of this site or any of its partners *
Required
Payment Method *
Football kit Size
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