30 Day Trial Membership

Name*
Title Name Surname
Mobile Phone*
Gender*
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Date of Birth*

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Email*
Address*
Street Address Address Line 2 Town County Post Code
Emergency Contact Name*
Full name
Relationship*
Emergency Contact Mobile*
Medical Information*
Please provide any relevant medical information the club coaches would need to be made aware of.
Declaration*
I agree to the Membership Terms & Conditions.
I confirm that I have read and fully understand the Membership Conditions and that the Rules and Regulations and Code of Practice will be adhered to at all times.
By ticking this form you are signing/agreeing to the declaration as stated above.
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