Olympic Wrestling Club SA

APPLICATION/REGISTRATION FORM FOR MEMBERSHIP

SURNAME ……………………………………….        Date:  ………….

FIRST NAME …………………………………………….………………

POSTAL ADDRESS……………………………………………….……..

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TELEPHONE (HOME) …………………………………………………..

                      (WORK) ……………………………………………………...

                      (MOBILE) ……………………………………………………

EMAIL ADDRESS……...…………………………………………………

DATE OF BIRTH ……………………….  Weight ……………

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Fees for Membership:

$10.00 Joining Fee + $20.00 per quarter coaching fee.

The above fees are compulsory and are made up of Insurance and affiliation fees to the South Australian Amateur Wrestling Assoc.

The first two sessions are free with no obligation to join.  The Joining Fee + $20.00 for the first quarter payment is required thereafter, and should be paid within 3 weeks of joining the club.

Medical Conditions: ……………………………………………………….

Current or Past Injuries ……………………………………………………

Current fitness level:     (Poor)   1        2        3         4        5  (Good)

Other current participating sports ………………………………………….

How did you hear about Wrestling Academy SA?………………………...

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Have you done wrestling before? Details: …………………………….......

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Applicant Signature: ……………………………….

(Parent to sign, if applicant is under 18 years old)

Office Use Only: Exp. Date _____________