Nantes Athletic Club Membership Registration Form
Kids & Juniors - R120
Seniors - R300
Pensioners - R150
Family - R300 (First member) R265 (Subsequent Senior members)

*Juniors are athletes below age 20 on 31 December 2022
*Copy of ID must be attached
Sign in to Google to save your progress. Learn more
Email *
I am a/an (Indicate all that apply) *
Required
Discipline (Indicate all that apply) *
Required
Title *
Full Name & Surname *
Gender *
Date of Birth (Day, Month, Year) *
Demographic (SRSA Requirement) *
ID/Passport Number *
Address *
Home/Cell Number *
Club Name *
ASA Province *
2021 License Number *
Will you purchase a 2022 WPA License? *
Occupation *
If occupation is "Other", please specify
Next of Kin *
Next of Kin Home/Cell Number *
Medical Aid Name & Plan
Medical Aid Number
Principle Member (Medical Aid)
Medical Conditions (Asthma, heart disease, etc. Please write "N/A" if Not Applicable) *
Chronic Medication (Please write "N/A" if Not Applicable) *
Blood Type *
General comments or questions
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms