Emergency & Medical Information Request Please complete and submit the formEmergency Contact and Medical InformationPlease complete this form with your up to date emergency contact and Medical information. Details will only be used in an emergency and all details will be kept strictly confidential.Please enable JavaScript in your browser to complete this form.First Name *Surname *Membership Type *Junior MemberAdult MemberEmergency Contact Phone NumberEmergency Contact Name *Emergency Contact Phone Number (additional)Additional number if required (ie, for Mother and Father)Emergency Contact Name (Additional)if requiredMedical Information *Any important medical information that we should be aware of?Medical Information *Do you have any medical or physical condition precluding heavy exercise? Medical Information *Do you consider yourself to have a disability?Submit
