Membership Application



 

Complete the details below to create a new member profile

Personal Details

Please enter a valid id/passport number
Please enter a name
Please enter a surname
Full Names field is required
Email field is required
Title field is required
Please select a date of birth in the format YYYY-MM-DD
Please enter a valid cellphone number

Membership Details



Additional information

Marital Status field is required
Occupation field is required
Other Contact Number field is required
Other Contact Number field is required
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PAR-Q


PARQ


Has your doctor ever confirmed that you have a heart condition? field is required
Has your doctor ever recommended you should only do physical activity as recommended by a doctor? field is required
Do you feel pain in your chest when you do physical activity? field is required
In the past month, have you had any chest pain when you were not doing any physical activity? field is required
Do you lose your balance because of any dizziness or do you ever lose consciousness? field is required
Do you have bone or joint problems that could be made worse by physical activity? field is required
Is your doctor currently prescribing any medication for your blood pressure or any heart condition? field is required
Do you know of any other reason why you should not do physical activity? field is required

How will you be paying:

Bank Details

These debit details belong to:
Please enter the account holder Initials
Please enter the account holder surname
 
Please enter a valid branch code
Please enter a valid account number
 
Select a valid account type
Select a valid debit date
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