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RTT-Membership Register Form

This from is used to collect basic memeber information and relevant sfaety

  1. Member Basic Information

Gender
Male
Female
Date of Birth
Day
Month
Year
Multi-line address

  1. Emergency Contact Information

  1. Health Information and Consent

Medication/Physical Limitation
No
Yes
Allergies
No
Yes

  1. Memebrt Information

Member Type
Annual Adult Pass
Annual Youth Pass (Under 18)
Super Gold Pass (Over 65)
99 Member

If Under18- Guardian information

OFFICE USE ONLY

To be completed by Radius staff after submission.

PAYMENT METHODS
Cash
Transfer
EFTPOS
Processing Status
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