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www.Longfei-Taiji.co.uk |
Longfei Taijiquan Association of Great Britain |
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LONGFEI TAIJIQUAN ASSOCIATION (GB)Membership application form |
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Surname: ____________________________________________________________________ Other name: _________________________________________________________________ Address: ____________________________________________________________________ Address: ____________________________________________________________________ Address: ____________________________________________________________________ Postcode: __________________Telephone: _____________________________________ Date of birth and current age:_______________________________________________ Email address: ______________________________________________________________ Your Instructor/Teachers name: ______________________________________________ Give details of previous martial arts experience (if any): _____________________________________________________________________________ Why do you want to practice Taijiquan? 1. Health/Relaxation [ ] 2. Self defence/Martial Application [ ] 3. Sport/Competition [ ] Do you suffer from any of the following? 1. Diabetes [ ] 2. Epilepsy [ ] 3. Haemophilia [ ] 4. Migraine [ ] 5. Hepatitis [ ] 6. Asthma [ ] 7. Heart disorder [ ] 8. Nervous disorder [ ] 9. Physical disability [ ] 10. Any other: ____________________________________________________________ Are you currently taking prescribed or non-prescribed medication? Yes/No [ ] If yes, please give details: ____________________________________________________________________________ If you have any doubts about your health, it would be advisable to consult your GP before participation. Is there any other information which you think might affect or influence your participation? Yes/No [ ] If yes, please give details: ________________________________________________ Signature __________________________________________ Date _____________ If the applicant is under 18 years of age, parent or guardian authorisation is required. Signature __________________________________________ Date _____________ Please print ths page and send with two cheques as follows: 1. £12.00 to LONGFEI TAIJI ASSOCIATION 2. £7.00 to the BCCMA to:- Longfei Membership Secretary, Karen Watson, 3, Westland Drive, Brookmans Park, HATFIELD, AL9 7UG.
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