Nelson Gymnasium Membership Registration
Nelson Gymnasium Membership Registration
Name
Name
*
First
Last
Date of Birth
Date of Birth
*
/
MM
/
DD
YYYY
Membership Type
*
Student
Staff
Community Youth
Community Adult
Community Senior
Date Purchased
Date Purchased
/
MM
/
DD
YYYY
Date Expired
Date Expired
/
MM
/
DD
YYYY
Selkirk College Student Number (if applicable)
Email
*
Phone
Phone
*
-
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-
###
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