LTW - Southall Club Membership - London Taekwondo Warriors

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First NameApplicant's first name

Last NameApplicant's last name

Date of Birthpick or type date of birthday dd/mm/yyyy

EmailOne valid email address can be used per application.

Phone NumberApplicant's / Parent’s / Guardian’s Mobile Phone

Submitted and Signed byApplicant's / Parent’s / Guardian’s Full Name

Address 1

Address 2

City

Post Code / ZIP

State / County

Country

Submission Dateof membership

Club Locationmake sure this is the location you applying for

Applicant Facial Imageupload 350 x 450 Pixel portrait for best resalt (only .png or .jpg)

Upload or Take a Student Photo

Membership NoYou need this to login to Student portal

Passwordset your own password for sign in to Student portal. Must be 6 to 15 charecters.(allow a-z A-Z alphabets, 0-9 numbers, undescore and hyphen)

DescriptionApplicant's Biography

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Applicant's / Parent’s / Guardian’s SignatureI agree to the terms and conditions

(Sign Here)

Clear Signature

Payment Confirmation: I confirm that recurring payment will be taken annually and I agree to the LTW - terms and conditions

Stripe Card Placeholder

Apply

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