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
Please select a date of birth in the format YYYY-MM-DD
Please enter a valid cellphone number

Membership Details

Please select a tariff

Additional information

Postal Code field is required
Emergency Contact Name field is required
Emergency Contact Relationship field is required
Parent / Legal Guardian Email field is required
ID number field is required
Postal Address field is required
Parent / Legal Guardian Contact Number field is required
Medical Aid Company field is required
Contract Number field is required
Parent / Legal Guardian Relationship field is required
Medical Aid No field is required
Occupation field is required
Parent / Legal Guardian Name and Surname field is required
PAR-Q Notes field is required
Emergency Contact Number field is required
Emergency Contact Email field is required

PAR-Q


Par-Q


In the past month, have you experienced any chest problems while not doing any physical activity? field is required
Have you ever had a hernia or any condition that may be aggravated by lifting weights? field is required
Do you have any history of breathing problems or lung problems? field is required
Is there any medical condition that you are aware of that would prevent you from participating in any physical activity or in swimming activities? field is required
Do you suffer from any chronic illness or condition that will be aggravated by physical activity? field is required
Do you suffer from diabetes or have a thyroid condition? field is required
Do you know of any other reason why you should not perform physical activity? field is required
Do you suffer from any muscle, joint or back disorder, or is there any previous injury still affecting you? field is required
Has your doctor advised you not to perform any physical activity due to your blood pressure? field is required
Are you pregnant or were you pregnant within the last three months? field is required
Do you ever lose consciousness or faint? field is required
Have you had any surgical procedures in the last 12 (twelve) months? 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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