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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)
Monthly Pass
Time Morning Pass
Time Afternoon Pass
Time Evening Pass

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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