2024 Member Registration Form
I am a
*
New Member
Existing Member
Members Name
*
First Name
Last Name
Members Date of Birth
*
-
Day
-
Month
Year
Date
Members Phone Number (if applicable)
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Area Code
Phone Number
Members Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Best Email Address for Invoicing
*
example@example.com
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Number
*
-
Area Code
Phone Number
Emergency Contact Relationship to Member
*
Parent/Guardian Contact Name for under 18s (if different to emergency contact)
First Name
Last Name
Parent/Guardian Contact Number
-
Area Code
Phone Number
I will be attending
*
Little Lakers
5-8 years
9-12 years
13-1st years
Seniors
Novice/Intermediate Ladies
Open Ladies
I last competed as ...
E.g. 5 years in 2022 or N/A if a new member
Please select payment option:
*
Pay annually by April 1st
Pay in 3 Installments
Do you give Lakeview Physie permission to use the members photo on social media and advertising?
*
Yes
No
How did you hear about us?
Do you have any medical requirements, disabilities, injuries or family arrangements that Lakeview Physie should be aware of?
Submit
Should be Empty: