Membership 2021
Please pay your membership using the link displayed after you submit this form. £10/adult £5/junior
Full Name *
Address *
postcode *
Date of birth *
MM
/
DD
/
YYYY
Contact number *
Emergency contact (name and number) *
Email address *
Any disability, long term illness or health problem *
Please indicate any medical conditions and allergies (IF YOU HAVE NO CONDITIONS OR ALLERGIES PLEASE WRITE NONE IN THE BOX) *
This includes heart conditions, asthma, diabetes, epilepsy, joint or back pain or existing injuries
Ethnicity
Clear selection
Gender
Clear selection
I consent to be included in club photography/video for publicity and promotion purposes. *
I have read and agree to current club policies and rules. *
Required
Name of gaurdian (if under 16)
Agreement on behalf of junior member
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