Personal DetailsTitleMrMrsMissDrOtherName* First Last Date of birth* Gender (M/F)MaleFemalePhone number*Email* Address* Street Address Address Line 2 City ZIP / Postal Code Emergency contactName* First Last RelationshipPhone number*Membership Type (please tick)Membership type*AdultStudentConcessionAccess type*On-PeakOff-peakPayment type*Monthly6-month12-monthMembership Start Date* Additional Members (please tick)Member 1NameDOB Phone numberMembership typeAdultStudentAccess typeOn-PeakOff-PeakMember 2NameDOB Phone numberMembership typeAdultStudentAccess typeOn-PeakOff-PeakMember 3NameDOB Phone numberMembership typeAdultStudentAccess typeOn-PeakOff-Peak Where did you hear about us? Where did you hear about us?MagazineInstagramFacebookWebsiteOtherDetails Membership Declaration To be completed by parent/guardian if member is under 18Full NamePhone numberEmail *I have read and agree to the AE Gyms Ltd Membership Terms and Conditions*I have read and agree to the AE Gyms Ltd Gym RulesSignature
