JUNIOR (Under 16) Membership

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Address *

Address2

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Phone *

Date of Birth *

18 or under? *

Yes

Parent / Guardian *

Emergency Tel *

Gender *

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Heart Disease

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From time to time we may want to use your name and/or photograph on the club website, club newsletter, local newspapers or club promotional material. Please choose 'Yes' below if you agree for us to use the above information and 'No' if you do not want to be included in any publications.

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JUNIOR (Under 16) Membership

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