3 minutes
Only members who are above the age of 21 years and in good health can fill the membership form.
Name
Address
City
State/Province
Postal/Zipcode
Home phone number
Cell phone number
Email address
Do you declare a disability?
If yes, please specify
Emergency contact details
Contact person name
Relationship
Emergency contact number
Have you, for any reason, been unable to exercise in the past?
Has your physician ever advised you against exercising?
Have you ever suffered from any cardiac (heart) related illness?
Have you experienced chest pain while exercising?
Do you have high blood pressure?
Are you currently taking prescribed medication?
Signature
Date