17 Clifton Road, Birmingham, B12 8SX
Ansaphone: 0121 440 0643
secretariat@ksmnet.org
Sunday, 22 July 2018  
8. Dhul Qadah 1439
AL-NAJIYAAT SPORTS MEMBERSHIP FORM
Membership runs from April 2017 to March 2018
Membership Charge: Under 16 years = £6.00 16 years and over = £12.00
PLEASE COMPLETE THE FOLLOWING INFORMATION
Please Note: Under 18's must print and hand in the form signed by Parent/Guardian
Participant’s Family Name:(*)
Please let us know your name.
First Name:(*)
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Date of Birth:(*)
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Age(*)
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Your Email(*)
Please let us know your email address.
Name of Parent/Guardian: Please state: Mr/Mrs/Miss/Ms/Other
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Present Address:(*)
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Postcode(*)
Please write a subject for your message.
Home Telephone:
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Mobile Number:(*)
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Receive Text Updates?
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Emergency Contact Name & Number:(*)
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Please provide details of two Contacts
Please provide any information regarding medical conditions that may be relevant:(*)
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Please tick which sport activities you wish to participate in:






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Signed:(*)
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Date of application:(*)
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Al Najiyaat Membership Fees(*)

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Spam Protection
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Submit form
For Offline Application, please download and complete the form below:

Please Note: Under 18's must print and hand in the form signed by Parent/Guardian.

Click here to download