Enrolment We are always happy to answer any questions.Marcos 021 024 58413 | headsbjj@gmail.com MEMBERSHIP ACCOUNT DETAILS Select primary gym location * Please select your primary gym location but know that your membership gives you access to both locations HQ gym, Walton Street, Whangarei City Taurikura Hall, Whangarei Heads Account Holder Name * Main contact for membership account First Name Last Name Phone * This number will be added to the class WhatsApp group. (###) ### #### Email * STUDENT DETAILS Student 1 * First Name Last Name Year of birth Please advise any health, physical or learning requirements Select program * KID 1 KID 2 ADULT LADIES Start date * MM DD YYYY Student 2 First Name Last Name Year of birth Please advise any health, physical or learning requirements Select program KID 1 KID 2 ADULT LADIES Start date MM DD YYYY EMERGENCY CONTACTS Emergency contact 1 * First Name Last Name Emergency contact phone * (###) ### #### Emergency contact 2 First Name Last Name Emergency contact phone (###) ### #### Your enrolment form has been submitted. You will shortly receive a secure link to our payment provider to complete your sign up.We look forward to seeing you on the mats!
