New Member / Update Membership New MembershipMembership update First Name (required) Surname (required) Title MrMrsMiss Address 1 Address 2 Address 3 Post Code Email Telephone No Date of Birth Age Occupation ________________________________________________________________ Previous Martial Art Experience By Whom Grade Where did you hear of this Organisation State precisely why you wish to learn Wing Chun Instructor Sifu Billy DavidsonSifu David McQuillanSifu Marcus WattsSifu Jon BensonSifu Liam dugganSifu Mike ThompsonSifu George PolitisSifu Jay HussainSifu Ashley DouglasSifu Murium Ghulam School ManchesterAbergeleHebden BridgeWarringtonBristolStretfordStockportBangorIpswichLadies Only ________________________________________________________________ I ……………………………… Agree to abide by my answers to the above details and, if for any reason, I desire to resign my membership I will do so in writing stating my reasons. I agree to uphold the constitution, rules and regulations of the Association at all times. I agree to abide by all laws, constitutions, agreements and commitments with the club at all times during my membership and after. I undertake training in Wing Chun entirely at my own risk and indemnify the club completely in respect of any injury, damage to my person and property at all times. ________________________________________________________________ APPLICANTS STATEMENT Condition of health Place of Exam Have you any Heart / Lung Trouble Have you High / Low Blood pressure Do you suffer from any organic, mental or physical disabilities or weaknesses ________________________________________________________________ I DECLARE THAT I AM FULLY FIT, BOTH MENTALLY AND PHYSICALLY Name Signed Date of Signature T-shirt size Δ
