Membership 2021
Please pay your membership using the link displayed after you submit this form. £10/adult £5/junior
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Full Name
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Your answer
Address
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postcode
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Date of birth
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MM
/
DD
/
YYYY
Contact number
*
Your answer
Emergency contact (name and number)
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Your answer
Email address
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Your answer
Any disability, long term illness or health problem
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Yes
No
Please indicate any medical conditions and allergies (IF YOU HAVE NO CONDITIONS OR ALLERGIES PLEASE WRITE NONE IN THE BOX)
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This includes heart conditions, asthma, diabetes, epilepsy, joint or back pain or existing injuries
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Ethnicity
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Black
Other
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Gender
Male
Female
Other
Prefer not to say
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I consent to be included in club photography/video for publicity and promotion purposes.
*
Yes
No
I have read and agree to current club policies and rules.
*
YES
Required
Name of gaurdian (if under 16)
Agreement on behalf of junior member
Your answer
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