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Membership Enquiry

Please complete the form below to enquire about joining The Barracuda Leisure Club.

Title: *

First Name: *

Surame: *

Address: *

Town/City: *

Country: *

Postcode: *

Date of Birth: * (dd/mm/yyyy)

Telephone: *

E-Mail: *

Company:

Other Names

1. Name:

Date of Birth: (dd/mm/yyyy)

2. Name:

Date of Birth: (dd/mm/yyyy)

3. Name:

Date of Birth: (dd/mm/yyyy)

4. Name:

Date of Birth: (dd/mm/yyyy)

Membership Type Required

Please select the membership type you are interested in.

Full Membership

	Annual	3 Months	6 Months	Monthly D/D
Single
Husband & Wife
Young Adult (16/17) with parent being a member
Child (under 16) Restricted times apply

Student

	Annual	3 Months	6 Months	Monthly D/D
Student

Off Peak

	Annual	3 Months	6 Months	Monthly D/D
Single
Husband & Wife

Off Peak Plus

	Annual	3 Months	6 Months	Monthly D/D
Single
Husband & Wife

Weekend

	Annual	3 Months	6 Months	Monthly D/D
Single
Husband & Wife

Additional questions/comments:

Have you previously been a member?: *

How did you hear of us: *

Why do you want to join: * (Please select as many as you wish) Weight Loss
Weight Gain
Strength
Improve General Fitness
General Toning
Social
Swimming
Relaxation
Training for a sport