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Create A New Profile

This registration information is used in a number of ways. First and foremost, it is the easiest way for us to collect the details we need to run the club safely (your emergency contact details, any allergies etc). Secondly, it ensures we have your up to date contact information to be able to keep you apprised of all the goings on with the club. Thirdly, to be able to record ergo scores, you need to have your student number on file. Fourthly, you'll soon use this username and password to add photos to the photo gallery.
There are no plans to restrict anonymous postings on the message board.
We will NEVER release your details to anyone outside of the club, only the captains and the safety officer of the club have access.

Username*: 
Email*: 
Password*: 
(This is stored in an encrypted state, even we can't read it!)
  (again)
 
First Name: 
Last Name: 
Date of Birth (dd-mm-yyyy): 
Student No: 
Without the slash or digits following it
Sex: 
 
Senior or Fresher: 
Do you cox: 
 
Telephone Number: 
Address Line 1: 
Address Line 2: 
Address Line 3: 
Address Post Code: 
 
Course: 
Expected Year of Graduation: 
 
ARA Number: 
ARA Number Expiry Date: 
 
Emergency Contact Name: 
Emergency Contact Phone (landline): 
Emergency Contact Phone (mobile): 
Emergency Contact Phone (work): 
 
Do you have any medical conditions
we should be aware of?: 
Do you require any form
of regular medication?: 
Do you have any allergies: 
Have you ever been advised
by a Doctor not to paticipate in
strenuous exercise?  
 
Can you swim
50m fully clothed?  
 
Do you agree to the rules
and regulations of the Club?  
 
Do you agree to letting
us store your information in an
electronic format? We will
not distrbute it to any
third party. 
 
Please type your surname to sign this form: 
Please enter todays date: 
Spam prevention:
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