Gym Membership Application Form 2015-2016

Name:

Address:

Home phone: Mobile phone:

Business phone:

Medical Information

Please give details of any medication you are taking

If you are male over 35, or female over 40 we highly recommend that you see your doctor for a health clearance prior

to training in the Wanda slsc Gym.

Emergency Contact Details

Name:

Address:

Home phone: Mobile phone:

Business phone: Relationship:

If you are younger than 27 years of age you must be an Active Patrolling Member unless you are Reserve Active or

Long Service Member that has been approved by the Board of Directors.

Type of membership

Cadet (13-15y) Life member

Active (15-18y) Long Service

Active (18y+) Award

Reserve Active Associate

Gym Fees

Active Patrol member $80.00 All other members $120.00 New Associate members $440.00

Cadets are only permitted in the Gym if accompanied by an experienced adult.

Please keep an eye on your personal belongings, as Wanda slsc takes NO responsibility for loss, damage or theft within

the gym.

All Gym members are required to provide assistance for the Wanda SLSC fund raising events (Sutherland to Surf,

Wanda intercities carnival, Spring classic etc...) Gym members that do not provide assistance WILL NOT have

their Gym membership renewed the following season.

Signature: Date:

Membership No: Receipt No: