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Membership Application Form
First Name
Middle
Last Name
Present Address
Phone Number (H)
(W)
(Cell)
Date of Birth
Country of Birth
National Identification No
Passport No:
Issued Date
Expired Date
Do you have a USA Visa
Yes
No
If Yes, Expire Visa Date
Child email Address
Parents email Address
Parents email Address(2)
Facebook Name
Facebook Name
Telephone Numbers (Mother)...
(Mother)...
Telephone Numbers (Father)...
(Father)...
BB/Whatsapp Numbers
BB/Whatsapp Numbers (2)
EMPLOYMENT
Name of Employer
Employer Address
PERSONNAL INFORMATION
Height
Weight
Shirt Size
Waist Size
Track Suit Size
Shoe Size
Boot Size
RELIGION
NAME OF PREVIOUS CLUBS
Position on the Field:
EDUCATIONAL INFORMATION
SCHOOL ATTENDED
FROM
To
QUALIFICATION
EXAMINATION BODY
SUBJECT
GRADE
LEVEL
USA SAT 1 SCORE
MEDICAL HISTORY
DO YOU SUFFER FROM?
ASTHMA
Yes
No
HEART DISEASE
Yes
No
DIABETES
Yes
No
HYPERTIONSION
Yes
No
EPILSEPSY
Yes
No
MIGRAME HEAD ACHE
Yes
No
OTHERS
PS. IF ANSWER TO ANY ABOVE IS (YES) PLEASE GIVE DETAILS INCLUDING NAME OF ANY SPECIAL MEDICATION.
Send
